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 | 2084D0003X | Psychiatry & Neurology | Diagnostic Neuroimaging | | | No |
| 2 | 171M00000X | Case Manager/Care Coordinator | | | | No |
| 3 | 163WP0807X | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | | | No |
| 4 | 103TM1800X | Psychologist | Intellectual and Developmental Disabilities | | | No |
| 5 | 2084E0001X | Psychiatry & Neurology | Epilepsy | | | No |
| 6 | 208000000X | Pediatrics | | | | No |
| 7 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 8 | 103TC2200X | Psychologist | Clinical Child & Adolescent | | | No |
| 9 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 10 | 2080P0008X | Pediatrics | Neurodevelopmental Disabilities | | | No |
| 11 | 103TB0200X | Psychologist | Cognitive & Behavioral | | | No |
| 12 | 2084N0402X | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | | | No |
| 13 | 2084N0400X | Psychiatry & Neurology | Neurology | | | Yes |
