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Provider Information for 1528533643


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RANDI NECOLE SENCIBOY LMSW, MAADC II


Sex: Female

NPI: 1528533643
Last Updated: 2018-10-04
Certification Date:

Details

NameValue
NPI1528533643
Enumeration Date2018-10-04
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address PO BOX 5
PERKINS, MO 63774-0005
United States

Phone: 618-806-3912 | Fax:
 
Primary Practice Address 619 N BROADVIEW ST
CAPE GIRARDEAU, MO 63701-4313
United States

Phone: 573-334-3496 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalMO2018031768