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 | | VARIOUS THERAPISTS | NEW YORK | No |
| 2 | 103TP0016X | Psychologist | Prescribing (Medical) | VARIOUS | NEW YORK | No |
| 3 | 104100000X | Social Worker | | VARIOUS LICENSES | NEW YORK | No |
| 4 | 251B00000X | Case Management | | NOT LICENSED IN NYS | NEW YORK | 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 | 02382218 | MEDICAID | NEW YORK | |
| 2 | 02994838 | MEDICAID | NEW YORK | |
| 3 | 8044479A | OTHER | NEW YORK | CASE MANAGEMENT OMH-OPERATING CERTIFICATE |
| 4 | 02717628 | MEDICAID | NEW YORK | |
| 5 | 8044025A | OTHER | NEW YORK | BEHAVIORAL HEALTH CLINIC-OMH OPERATING CERTIFICATE |
| 6 | 01212142 | MEDICAID | NEW YORK | |
| 7 | BA1047 | OTHER | | MCR PTAN |
