Garrett A Randolph, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC16749 Issued in ME

Practice address

163 Forest Ave
Orono, ME 04473

Phone

(207) 356-1622

NPI assigned

Nov 2, 2017

Last updated

Jan 5, 2024By the provider in NPPES

Sex

Male

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1942712773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 FOREST AVE",
            "city": "ORONO",
            "state": "ME",
            "postal_code": "044734723",
            "telephone_number": "207-356-1622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 FOREST AVE",
            "city": "ORONO",
            "state": "ME",
            "postal_code": "04473",
            "telephone_number": "207-356-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "GARRETT",
        "middle_name": "A",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-02",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC16749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Constance A Poulin, LCSW CCS
• Robyn L Pride
• John Quinn, LCSW
• Glenn Stephen Rampe, M.D.
• Benjamin Randall, ATC
• Renew Health PLLC
• Susan Kay Riley, MS CCCSLP
• Daryne M Rockett, LCSW
• Joanna Fichthorn Rosebush, PHD
• Rowe Dental LLC

• Clinical Social Worker in Orono, ME
• Providers in Orono, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.