| Doctor Name: | MS. JESSICA LYNN RANDOLPH |
| NPI Number: | 1285754366 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC,CRC |
| License Number: | 000096 |
| Business Practice Address: | 201 I U Willets Rd Vocational Evaluation Albertson, NY - 115071516 |
| Business Phone Number: | 5164651522 |
| Business Fax Number: | |
| Mailing Address: | 20 Firwood Rd, Apt 1 PORT WASHINGTON |
| State: | NY |
| Postal Code: | 110501510 |
| Phone Number: | 5164674425 |
| Fax Number: | |
| NPI Enumeration Date: | 03/30/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 000096 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |