| Doctor Name: | MR. RANDALL BERWIN PETTIT |
| NPI Number: | 1003241803 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW |
| License Number: | 071208 |
| Business Practice Address: | 6700 N Oracle Rd Ste 505 Tucson, AZ - 857047736 |
| Business Phone Number: | 5207919974 |
| Business Fax Number: | 5207910676 |
| Mailing Address: | 6700 N Oracle Rd Ste 505, TUCSON |
| State: | AZ |
| Postal Code: | 857047736 |
| Phone Number: | 5207919974 |
| Fax Number: | 5207910676 |
| NPI Enumeration Date: | 09/11/2013 |
| NPI Last Update Date: | 09/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 071208 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |