Lily Randall, PsyD
Psychologist in San Clemente, CA. Individual provider (NPI-1).
NPI number1831615467
StatusActive
Last updated in NPPESOct 21, 2020
Details
- NPI
- 1831615467
- Entity type
- Individual (NPI-1)
- Name
- Lily Randall
- Credential
- PsyD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 15, 2017
- Certification date
- Oct 21, 2020
- Last updated
- Oct 21, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- Medicare opt-out
- Aug 2, 2021 to Aug 2, 2027
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | – | – | Yes |
Practice location
629 Camino De Los Mares Ste 207aSan Clemente, CA 92673-2832
Phone 714-345-5200
Mailing address
629 Camino De Los Mares Ste 207aSan Clemente, CA 92673-2832
Phone 714-345-5200
Other practice locations
1301 Pine Ave
Long Beach, CA 90813-3124
Long Beach, CA 90813-3124
Phone 562-595-1159
30250 Rancho Viejo Rd Ste G
San Juan Capistrano, CA 92675-1562
San Juan Capistrano, CA 92675-1562
Phone 949-444-6741
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 10 Psychologist providers in San Clemente · All 1,327 providers in San Clemente
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