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Individual
RANDALL BRUCE MINTEER
Active
Individual
RANDALL BRUCE MINTEER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
20221
MD
1041C0700X
Clinical Social Worker
Primary
20221
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
259147-000
MAGELLAN BEHAVIORAL HEALTH
MD
01
—
346646
MHN/TRICARE
MD
01
—
522156095
COMMERCIAL
MD
05
—
609550002
—
MD
01
—
7840093
AETNA
MD
01
—
R968
CAREFIRST BCBS OF MARYLAND
MD
Enumeration date
11/20/2014
Last updated
10/08/2019
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