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 | 101YM0800X | Counselor | Mental Health | 400930 | PENNSYLVANIA | No |
| 2 | 251S00000X | Community/Behavioral Health | | 400930 | PENNSYLVANIA | 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 | 1892851 | OTHER | PENNSYLVANIA | HIGHMARK DOCTOR |
| 2 | 612225900 | OTHER | PENNSYLVANIA | US DEPARTMENT OF LABOR |
| 3 | 850486 | OTHER | PENNSYLVANIA | HIGHMARK |
| 4 | ========= | OTHER | PENNSYLVANIA | MH NET |
| 5 | 830412 | OTHER | PENNSYLVANIA | HIGHMARK |
| 6 | 1007449820011 | MEDICAID | PENNSYLVANIA | |
| 7 | DG1033 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE/PALMETTO GBA |
| 8 | 332310 | OTHER | PENNSYLVANIA | VALUE OPTIONS |
| 9 | 259666000 | OTHER | PENNSYLVANIA | MAGELLAN BEHAVIORALHEALTH |
| 10 | X63366 | MEDICARE UPIN | PENNSYLVANIA | |
| 11 | 1007449820013 | MEDICAID | PENNSYLVANIA | |
| 12 | 1000689 | OTHER | PENNSYLVANIA | COMMUNITY CARE BEHAVIORAL |
| 13 | 000000212529 | OTHER | PENNSYLVANIA | UNISON HEALTH PLAN |
| 14 | 0007758127 | OTHER | PENNSYLVANIA | AETNA BEHAVIORAL HEALTH |
| 15 | ========= | OTHER | PENNSYLVANIA | INTERGROUP SERVICES CORPORATION |
| 16 | 1007449820011 | OTHER | PENNSYLVANIA | CBHNP |
| 17 | 317380 | OTHER | PENNSYLVANIA | UPMC HEALTH PLAN |
| 18 | 2173831 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE |
| 19 | 050541P1M | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | MEDICARE GROUP ID |
| 20 | ========= | OTHER | PENNSYLVANIA | BWC-OHIO BETTER WORKER'S |
