Active NPI
Mary M. Randlett, PH.D.
- Psychologist
- Saint Louis, MO
National Provider Identifier
1811027451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- R0010
- Practice address
- 4231 Laclede Ave
Saint Louis, MO 63108-2814 - Phone
- (314) 535-5200
- Fax
- (314) 289-9983
- NPI assigned
- Mar 6, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | R0010 | MO | Primary |
Addresses
Primary practice location
4231 Laclede Ave
Saint Louis, MO 63108-2814
Mailing address
4231 Laclede Ave
Saint Louis, MO 63108-2814
Phone (314) 535-5200
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0010 | MO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811027451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4231 LACLEDE AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631082814",
"telephone_number": "314-535-5200",
"fax_number": "314-289-9983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4231 LACLEDE AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631082814",
"telephone_number": "314-535-5200",
"fax_number": "314-289-9983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDLETT",
"first_name": "MARY",
"middle_name": "M.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "R0010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
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.