Marianna Randolph, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 24256 Issued in CA

Practice address

924 Emerald Bay Rd
South Lake Tahoe, CA 96150-9405

Phone

(530) 721-7281

NPI assigned

Oct 6, 2011

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• A Balanced Life: Individual, Family and Child Therapy, Inc

  • Mental Health Counselor
  • South Lake Tahoe, CA
  • NPI 1083153837
  NPD (past)
• Pathways Community Services LLC

  dba CYS Clarvida - Tustin

  • Community/Behavioral Health Agency
  • Tustin, CA
  • NPI 1396436077
  NPD (past)

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1609150853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9343",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961582343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 EMERALD BAY RD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961509405",
            "telephone_number": "530-721-7281"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Eloise Ave",
            "address_purpose": "LOCATION",
            "city": "South Lake Tahoe",
            "state": "CA",
            "postal_code": "961504306",
            "country_code": "US",
            "telephone_number": "530-544-1748",
            "fax_number": "530-544-1728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "MARIANNA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-06",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 24256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Quazzo
• Quick Care Tahoe Providers Medical Corporation (Quick Care Tahoe)
• Mia Raab, BSN, RN, PHN
• Jessica Woods Rafferty, PTA
• Raleys
• Robyn R Rasmussen, MS
• Debra Annette Rau-Jacques, PT
• Elizabeth Howe Ravenel, CA LMFT 131814
• Candice Lauren Raynor, NP
• Reach Air Medical Services LLC

• Clinical Social Worker in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.