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DR. JOHN JAMES RANDOLPH PH.D.

Behavioral Health & Social Service Providers Clinical Neuropsychologist

Provider NPI: 1700881463

Provider Information:
DR. JOHN JAMES RANDOLPH PH.D.
Gender: M
Sole Proprietor

Practice Location:
20 W PARK ST STE 215 LEBANON, NH 03766-1378 US
Tel: 603-448-6779  Fax: 603-653-0246

Business Mailing Address:
20 W PARK ST SUITE 215 LEBANON, NH 03766-1378 US
Tel: 603-653-0330  Fax: 603-653-0330

NPI Information:
NPI: 1700881463
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
NH1027
N103T00000XBehavioral Health & Social Service Providers
Psychologist
NH1027

Other Provider Identifiers:

IssuerNumberStateType
BLUE CROSS BLUE SHIELD00068596VT01
ANTHEM BLUE CROSS BLUE SH06Y007347NH01NH01



American Medical Association 2012 taxonomy code information

Code: 103G00000X

Type:

Classification:



Definition:



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