Provider Demographics
NPI:1053960427
Name:SISCO, RANDI L (LCSW)
Entity type:Individual
Prefix:MS
First Name:RANDI
Middle Name:L
Last Name:SISCO
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RANDI
Other - Middle Name:L
Other - Last Name:SISCO-STUDNITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:905 GREENE COUNTY OFFICE BLDG.
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-9511
Mailing Address - Country:US
Mailing Address - Phone:518-622-9163
Mailing Address - Fax:518-621-4228
Practice Address - Street 1:905 GREENE COUNTY OFFICE BLDG.
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-9511
Practice Address - Country:US
Practice Address - Phone:518-622-9163
Practice Address - Fax:518-621-4228
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095887-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical