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 | | | | No |
| 2 | 207R00000X | Internal Medicine | | | | No |
| 3 | 208000000X | Pediatrics | | | | No |
| 4 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 5 | 225100000X | Physical Therapist | | | | No |
| 6 | 225X00000X | Occupational Therapist | | | | No |
| 7 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 8 | 251B00000X | Case Management | | | | No |
| 9 | 252Y00000X | Early Intervention Provider Agency | | | | No |
| 10 | 261QD1600X | Clinic/Center | Developmental Disabilities | 2701234R | NEW YORK | No |
| 11 | 261QM0850X | Clinic/Center | Adult Mental Health | 7773002A | NEW YORK | No |
| 12 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | 7773002A | NEW YORK | No |
| 13 | 261QM1300X | Clinic/Center | Multi-Specialty | 2701234R | NEW YORK | No |
| 14 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 15 | 101YM0800X | Counselor | Mental Health | | | 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 | 02324418 | MEDICAID | NEW YORK | |
| 2 | 334532 | MEDICARE OSCAR/CERTIFICATION | NEW YORK | |
| 3 | 336522 | MEDICARE OSCAR/CERTIFICATION | NEW YORK | |
| 4 | AA1460 | MEDICARE UPIN | NEW YORK | |
