Lily Randall, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

629 Camino de Los Mares Ste 207a
San Clemente, CA 92673-2832

Phone

(714) 345-5200

NPI assigned

Aug 15, 2017

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 2, 2021 through Aug 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Atencio / Maclean Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Juan Capistrano, CA
  • NPI 1871097303
  NPD (past)

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1831615467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 CAMINO DE LOS MARES STE 207A",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732832",
            "telephone_number": "714-345-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 CAMINO DE LOS MARES STE 207A",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732832",
            "telephone_number": "714-345-5200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Pine Ave",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908133124",
            "country_code": "US",
            "telephone_number": "562-595-1159",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30250 Rancho Viejo Rd Ste G",
            "address_purpose": "LOCATION",
            "city": "San Juan Capistrano",
            "state": "CA",
            "postal_code": "926751562",
            "country_code": "US",
            "telephone_number": "949-444-6741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "LILY",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-15",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cora D Rall
• Ralphs Grocery Company
• Ramin Tayani MD Inc
• Gabriella Ellyse Ramirez, PT, DPT
• Kayla Ramsey, DO
• Melissa Ray
• Raymond L. Wright Jr DDS PC
• Brendon Rearick
• Erini Papandreas Redmond, DDS
• Michael John Redmond, DDS, MS

• Psychologist in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.