Individual
TANA V RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
56 W TWIN OAKS TER, SOUTH BURLINGTON, VT 05403-7106
(802) 847-3333
(802) 847-1424
Mailing address
PO BOX 286, MILTON, VT 05468-0286
(802) 343-1614
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089-0000997
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011510
—
VT
Enumeration date
08/23/2006
Last updated
07/08/2007
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