Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 103T00000X | Psychologist | | PSY 20679 | CALIFORNIA | No |
| 2 | 103TA0700X | Psychologist | Adult Development & Aging | PSY 20679 | CALIFORNIA | No |
| 3 | 103TB0200X | Psychologist | Cognitive & Behavioral | PSY 20679 | CALIFORNIA | No |
| 4 | 103TC0700X | Psychologist | Clinical | PSY 20679 | CALIFORNIA | No |
| 5 | 103TC2200X | Psychologist | Clinical Child & Adolescent | PSY 20679 | CALIFORNIA | No |
| 6 | 103TF0200X | Psychologist | Forensic | PSY 20679 | CALIFORNIA | No |
| 7 | 103TH0004X | Psychologist | Health | PSY 20679 | CALIFORNIA | No |
| 8 | 103TM1800X | Psychologist | Intellectual and Developmental Disabilities | PSY 20679 | CALIFORNIA | No |
| 9 | 103TP2701X | Psychologist | Group Psychotherapy | PSY 20679 | CALIFORNIA | No |
| 10 | 103TR0400X | Psychologist | Rehabilitation | PSY 20679 | CALIFORNIA | No |
| 11 | 103G00000X | Clinical Neuropsychologist | | PSY 20679 | CALIFORNIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | CT333A | OTHER | CALIFORNIA | MEDICARE PTAN |
