Summerville, Randall Warren

Summerville, Randall Warren is an sole proprietor health care provider with primary practice located at 477 E Butterfield Rd Ste 102 , Lombard IL 60148-4880. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Adult Development & Aging, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Summerville, Randall Warren can be contacted via phone (630) 424-8900.

Contact Information

Primary practice address
477 E Butterfield Rd Ste 102 Lombard IL 60148-4880
Phone: (630) 424-8900
Fax: (630) 424-9017
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 071-006658 Illinois
Behavioral Health & Social Service Providers / Adult Development & Aging 103TA0700X 071-006658 Illinois
Behavioral Health & Social Service Providers / Clinical 103TC0700X 071-006658 Illinois

Profile Details

NPI number 1821180803
LBN Legal business name Summerville, Randall Warren
Credentials PSYD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 28th, 2006
Last updated Dec 5th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821180803 NPPES
Illinois Other 02233000 BCBS OF IL GROUP PROVIDER
Illinois Other 071-0006658 BCBS OF IL GROUP PROVIDER

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