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 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | | | No |
| 3 | 172V00000X | Community Health Worker | | | | No |
| 4 | 207Q00000X | Family Medicine | | | | No |
| 5 | 207QG0300X | Family Medicine | Geriatric Medicine | | | No |
| 6 | 207R00000X | Internal Medicine | | | | Yes |
| 7 | 207RG0300X | Internal Medicine | Geriatric Medicine | | | No |
| 8 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 9 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 10 | 363A00000X | Physician Assistant | | | | No |
| 11 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 12 | 363LP2300X | Nurse Practitioner | Primary Care | | | No |