Tyantha G. Randall, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

13117 Issued in MD

Practice address

104 Williamsport Cir
Suite C
Salisbury, MD 21804-6400

Phone

(443) 859-8699

Fax

(443) 859-8747

NPI assigned

Jun 26, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brightside Medical, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1801355482

  MD

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1407052400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WILLIAMSPORT CIR",
            "address_2": "SUITE C",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046400",
            "telephone_number": "443-859-8699",
            "fax_number": "443-859-8747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WILLIAMSPORT CIR",
            "address_2": "SUITE C",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046400",
            "telephone_number": "443-859-8699",
            "fax_number": "443-859-8747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "TYANTHA",
        "middle_name": "G.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-26",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "13117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "744800100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samah N Ramadan-Nassar, P.A.
• Ramesh K. Agarwal, M.D., P.a.
• Karthik Ramireddy, MD
• Raheem Ramsey
• Monyae Pearline Randall, PA-C
• Alexis Randazzo
• James Anthony Rano, D.P.M.
• Parveen A Rawala
• Karen E. Ray, LCPC
• Lindsay Corinne Ray, LMSW

• Clinical Social Worker in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.