Active NPI
Jessica Lynn Randolph, LMHC,CRC
- Mental Health Counselor
- Albertson, NY
National Provider Identifier
1285754366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 000096
- Practice address
- 201 I U Willets Rd
Vocational Evaluation
Albertson, NY 11507-1516 - Phone
- (516) 465-1522
- NPI assigned
- Mar 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 000096 | NY | Primary |
Addresses
Primary practice location
201 I U Willets Rd
Vocational Evaluation
Albertson, NY 11507-1516
Mailing address
20 Firwood Rd
Apt 1
Port Washington, NY 11050-1510
Phone (516) 467-4425
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000096 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285754366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 FIRWOOD RD",
"address_2": "APT 1",
"city": "PORT WASHINGTON",
"state": "NY",
"postal_code": "110501510",
"telephone_number": "516-467-4425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 I U WILLETS RD",
"address_2": "VOCATIONAL EVALUATION",
"city": "ALBERTSON",
"state": "NY",
"postal_code": "115071516",
"telephone_number": "516-465-1522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "JESSICA",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "LMHC,CRC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "000096",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albertson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.