LILY RANDALL PSYD
NPI 1831615467
Psychologist in San Clemente, CA

Active since August 15, 2017Opted out of Medicare · through Aug 2, 2027
629 CAMINO DE LOS MARES STE 207A, SAN CLEMENTE, CA 92673(714) 345-5200 Get Directions Write a Review

NPPES record last updated: October 21, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 21, 2020, Aug 15, 2017 (2 updates tracked since 2017).

About Lily Randall Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LILY RANDALL PSYD (NPI 1831615467) is an individual psychologist in San Clemente, California and active in the NPI registry since August 2017. She has opted out of Medicare through August 2, 2027 and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1831615467
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameLILY RANDALLCredential: PSYD
Location Address629 CAMINO DE LOS MARES STE 207ASan Clemente, CA 92673-2832
Mailing Address629 Camino De Los Mares Ste 207aSan Clemente, CA 92673-2832 · (714) 345-5200
Sole ProprietorNo
Enumeration DateAugust 15, 2017
Last NPPES UpdateOctober 21, 20202 updates tracked since enumeration
NPPES CertifiedOctober 21, 2020
NPI 1831615467 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
629 CAMINO DE LOS MARES STE 207A, San Clemente, CA 92673

Secondary Practice Locations 2

Location 130250 Rancho Viejo Rd Ste GSan Juan Capistrano, CA 92675-1562 · Phone (949) 444-6741
Location 21301 Pine AveLong Beach, CA 90813-3124 · Phone (562) 595-1159

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Lily Randall Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from August 2, 2021 through August 2, 2027.

Opt-Out Effective DateAugust 2, 2021
Opt-Out In Effect ThroughAugust 2, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychologist (Clinical)
629 CAMINO DE LOS MARES STE 207A
SAN CLEMENTE, CA 92673

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lily Randall's NPI number?

The NPI number for Lily Randall is 1831615467. It was assigned to this individual provider in the NPPES registry on August 15, 2017.

Where is Lily Randall located?

Lily Randall practices at 629 Camino De Los Mares Ste 207A, San Clemente, CA 92673. The listed phone number is (714) 345-5200.

What is Lily Randall's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Lily Randall enrolled in Medicare?

No. Lily Randall has opted out of Medicare through August 2, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Lily Randall was last updated on October 21, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.