Provider Demographics
NPI:1548309206
Name:LUCENTE, RANDOLPH LEE (MSW PHD)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:LEE
Last Name:LUCENTE
Suffix:
Gender:M
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 WRIGHT COURT
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-367-7027
Mailing Address - Fax:
Practice Address - Street 1:228 EAST NORTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067
Practice Address - Country:US
Practice Address - Phone:847-680-4468
Practice Address - Fax:312-915-7645
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005294490OtherAETNA INSURANCE
IL0001622515OtherBLUE CROSS BLUE SHIELD