Provider Demographics
NPI:1861501827
Name:SCHNUR, RANDI (PHD)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:
Last Name:SCHNUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CHAMBERLAIN HWY
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1921
Mailing Address - Country:US
Mailing Address - Phone:860-893-0040
Mailing Address - Fax:860-893-0046
Practice Address - Street 1:26 CHAMBERLAIN HWY
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1921
Practice Address - Country:US
Practice Address - Phone:860-893-0040
Practice Address - Fax:860-893-0046
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001722103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
134311OtherVALUE OPTIONS
080194OtherMHN
CT004133774Medicaid
060001722CT02OtherANTHEM BC/BS
P382518OtherOXFORD
4459559OtherAETNA
P382518OtherOXFORD