Active NPI
Tina Nicole Randolph, LISW
- Clinical Social Worker
- Dover Afb, DE
National Provider Identifier
1780172973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.2002316
- Practice address
- 300 Tuskegee Blvd
Dover Afb, DE 19902-5003 - Phone
- (302) 677-2674
- NPI assigned
- Apr 24, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 23300 | MD | |
| Clinical Social Worker | 1041C0700X | I.2002316 | OH | Primary |
Addresses
Primary practice location
300 Tuskegee Blvd
Dover Afb, DE 19902-5003
Mailing address
300 Tuskegee Blvd
Dover Afb, DE 19902-5003
Phone (302) 677-2674
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 |
|---|---|---|---|
| I.2002316 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638230400000",
"number": "1780172973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 TUSKEGEE BLVD",
"city": "DOVER AFB",
"state": "DE",
"postal_code": "199025003",
"telephone_number": "302-677-2674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 TUSKEGEE BLVD",
"city": "DOVER AFB",
"state": "DE",
"postal_code": "199025003",
"telephone_number": "302-677-2674"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "TINA",
"middle_name": "NICOLE",
"credential": "LISW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-24",
"last_updated": "2021-11-30",
"certification_date": "2021-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MD",
"license": "23300",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.2002316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dover Afb, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.