Active NPI
Randy Naylor, LICSW, LP
- Clinical Psychologist
- Red Wing, MN
National Provider Identifier
1972558302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP1609
- Practice address
- 426 West Ave
Red Wing, MN 55066-2473 - Phone
- (651) 385-6180
- Fax
- (651) 385-6195
- NPI assigned
- May 24, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP1609 | MN | Primary |
Addresses
Primary practice location
426 West Ave
Red Wing, MN 55066-2473
Mailing address
426 West Ave
Red Wing, MN 55066-2473
Phone (651) 385-6180
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01013344 | Other | PREFERRED ONE | |
| 117956 | Other | U-CARE | |
| 247057800 | Medicaid | MN | |
| 62-69127 | Other | MEDICA | |
| 61Q73NA | Other | BX/BS | |
| 5115551 | Other | AETNA | |
| 855661013344 | Other | PREFERREDONE ADMINISTRATI |
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 |
|---|---|---|---|
| LP1609 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221091200000",
"number": "1972558302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "426 WEST AVE",
"city": "RED WING",
"state": "MN",
"postal_code": "550662473",
"telephone_number": "651-385-6180",
"fax_number": "651-385-6195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "426 WEST AVE",
"city": "RED WING",
"state": "MN",
"postal_code": "550662473",
"telephone_number": "651-385-6180",
"fax_number": "651-385-6195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAYLOR",
"first_name": "RANDY",
"credential": "LICSW, LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-24",
"last_updated": "2008-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP1609",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "01013344",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U-CARE",
"identifier": "117956",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "247057800",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "62-69127",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BX/BS",
"identifier": "61Q73NA",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5115551",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE ADMINISTRATI",
"identifier": "855661013344",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Red Wing, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.