Shannon Alyse Randolph | Roxbury, MA • PECOS Search

Shannon Alyse Randolph

Social Worker

Behavioral Health & Social Service Providers

504 Dudley St, Roxbury, MA 02119-2732

(617) 445-6655 (617) 638-7147

PECOS Enrollment

Based on the most recent information from CMS, provider Shannon Alyse Randolph does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records today at 12:07 PM.

Profile Details

Provider ID
1821767922
Provider Type
Individual
Full Name
Randolph, Shannon Alyse
Title
Miss
Credential
MSW, LICSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
9/10/2021
Last Updated
5/6/2025

Contact Information

Practice Location

504 Dudley St, Roxbury, MA 02119-2732

Unlisted Fax

Mailing Location

1 Bmc Place, Moakley Connector Office 1301, Boston, MA 02118

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License LICSW1121000 Massachusetts