| Doctor Name: | RANDY ALLEN DYMOND |
| NPI Number: | 1407033640 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., M.P.A. |
| License Number: | R-27930-1 |
| Business Practice Address: | Central New York Psychiatric Center, Old River Road Marcy, NY - 13403 |
| Business Phone Number: | 3157653647 |
| Business Fax Number: | 3157653659 |
| Mailing Address: | Po Box 300, Central New York Psychiatric Center, Old River Road MARCY |
| State: | NY |
| Postal Code: | 13403 |
| Phone Number: | 3157653647 |
| Fax Number: | 3157653659 |
| NPI Enumeration Date: | 01/30/2008 |
| NPI Last Update Date: | 01/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R-27930-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| 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 |