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 | 103G00000X | Clinical Neuropsychologist | | | | Yes |
| 2 | 103T00000X | Psychologist | | | | No |
| 3 | 103TP2701X | Psychologist | Group Psychotherapy | | | No |
| 4 | 163WP0808X | Registered Nurse | Psychiatric/Mental Health | | | No |
| 5 | 167G00000X | Licensed Psychiatric Technician | | | | No |
| 6 | 2080P0008X | Pediatrics | Neurodevelopmental Disabilities | | | No |
| 7 | 2084F0202X | Psychiatry & Neurology | Forensic Psychiatry | | | No |
| 8 | 2084N0400X | Psychiatry & Neurology | Neurology | | | No |
| 9 | 2084N0402X | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | | | No |
| 10 | 2084P0301X | Psychiatry & Neurology | Brain Injury Medicine | | | No |
| 11 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 12 | 363A00000X | Physician Assistant | | | | No |
| 13 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |