Provider Demographics
NPI:1528383593
Name:RANDALL-SUNGAR, KATIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:RANDALL-SUNGAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 ARBORETUM WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3829
Mailing Address - Country:US
Mailing Address - Phone:413-652-5746
Mailing Address - Fax:
Practice Address - Street 1:26 CHESTNUT ST STE 2E
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3600
Practice Address - Country:US
Practice Address - Phone:978-749-2700
Practice Address - Fax:978-749-2709
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MAPSY5000413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist