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 | 101YP2500X | Counselor | Professional | | | No |
| 2 | 103T00000X | Psychologist | | | | No |
| 3 | 1041C0700X | Social Worker | Clinical | | | No |
| 4 | 207RC0000X | Internal Medicine | Cardiovascular Disease | | | No |
| 5 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | | | Yes |
| 6 | 207VG0400X | Obstetrics & Gynecology | Gynecology | | | No |
| 7 | 207VX0000X | Obstetrics & Gynecology | Obstetrics | | | No |
| 8 | 207VX0201X | Obstetrics & Gynecology | Gynecologic Oncology | | | No |
| 9 | 208800000X | Urology | | | | No |
| 10 | 208VP0000X | Pain Medicine | Pain Medicine | | | No |
| 11 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | | | No |
| 12 | 207VF0040X | Obstetrics & Gynecology | Urogynecology and Reconstructive Pelvic Surgery | | | No |
| 13 | 2088F0040X | Urology | Urogynecology and Reconstructive Pelvic Surgery | | | No |