Individual
DR. ALICE H RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDD MSCP
Contact information
Practice address
3872 E HARBOR LIGHT LANDING DR, PORT CLINTON, OH 43452-3877
(216) 215-8000
(877) 734-2032
Mailing address
205 SE CATAWBA RD, SUITE A, PORT CLINTON, OH 43452-2666
(216) 215-8000
(877) 734-2032
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2974
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000137850
ANTHEM
OH
05
—
0473590
—
OH
01
—
294762000
MAGELLAN
OH
01
—
P00127008
RAILROAD MEDICARE
OH
Enumeration date
08/30/2006
Last updated
07/21/2022
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