Provider Demographics
NPI:1861930786
Name:RANDO, KENNETH C (LCSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:RANDO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 PADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7044
Mailing Address - Country:US
Mailing Address - Phone:203-630-6356
Mailing Address - Fax:
Practice Address - Street 1:883 PADDOCK AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-7044
Practice Address - Country:US
Practice Address - Phone:203-630-6356
Practice Address - Fax:203-634-7089
Is Sole Proprietor?:No
Enumeration Date:2017-02-11
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0034141041C0700X
CT109131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical