Provider Demographics
NPI:1083108641
Name:RANDAZZO, GINA (BCBA, COBA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3339
Mailing Address - Country:US
Mailing Address - Phone:330-668-4041
Mailing Address - Fax:
Practice Address - Street 1:7580 NORTHCLIFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3270
Practice Address - Country:US
Practice Address - Phone:248-846-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01002103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst