Individual
EMILY A RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
141 E MAIN ST, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Mailing address
2 OLD NEW MILFORD ROAD, SUITE 1-B, BROOKFIELD, CT 06804
(203) 775-2583
(203) 775-2863
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2218
CT
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060669107
HEALTHYCT WELLMORE GRP/FACILITY
CT
01
—
13671806
CAQH
CT
01
—
NOT ELIGIBLE
BEACON HEALTH STRATEGIES
CT
01
—
PENDING
CIGNA BEHAVIORAL HEALTH
CT
05
—
PENDING
—
CT
Enumeration date
07/28/2014
Last updated
04/10/2019
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