Individual
MS. LORI S RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.ED
Contact information
Practice address
12 EVERGREEN LN, SUITE 1, WALDEN, NY 12586-1662
(718) 502-5298
Mailing address
12 EVERGREEN LN, SUITE 1, WALDEN, NY 12586-1662
(718) 502-5298
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1679782
NY
Other
Enumeration date
07/16/2012
Last updated
07/16/2012
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