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 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 2 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | No |
| 3 | 2084P0805X | Psychiatry & Neurology | Geriatric Psychiatry | | | No |
| 4 | 101Y00000X | Counselor | | | | No |
| 5 | 104100000X | Social Worker | | | PENNSYLVANIA | No |
| 6 | 103G00000X | Clinical Neuropsychologist | | | | No |
| 7 | 103T00000X | Psychologist | | | | No |
| 8 | 363L00000X | Nurse Practitioner | | | | No |
| 9 | 1041C0700X | Social Worker | Clinical | | | No |
| 10 | 2084P0005X | Psychiatry & Neurology | Neurodevelopmental Disabilities | | | No |
| 11 | 2084N0400X | Psychiatry & Neurology | Neurology | | | No |
| 12 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 13 | 2084N0402X | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | | | No |
| 14 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 15 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | 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 | 2091237 | OTHER | PENNSYLVANIA | BLUE SHIELD |
| 2 | 306906 | OTHER | PENNSYLVANIA | MANAGED HEALTH NETWORK |
| 3 | 7162248 | OTHER | PENNSYLVANIA | AETNA |
| 4 | 2081591 | OTHER | PENNSYLVANIA | CIGNA BEHAVIORAL HEALTH |
| 5 | 100772136 0360 | MEDICAID | PENNSYLVANIA | |
| 6 | 2164697 | OTHER | PENNSYLVANIA | CIGNA BEHAVIORAL HEALTH |
| 7 | 1681714 | OTHER | PENNSYLVANIA | BLUE SHIELD |
| 8 | 2081597 | OTHER | PENNSYLVANIA | CIGNA BEHAVIORAL HEALTH |
| 9 | 02303700 | OTHER | | CAPITAL BLUE CROSS |
| 10 | 100772136 | MEDICAID | PENNSYLVANIA | |
| 11 | 2081595 | OTHER | PENNSYLVANIA | CIGNA BEHAVIORAL HEALTH |
| 12 | 2148186 | OTHER | PENNSYLVANIA | CIGNA BEHAVIORAL HEALTH |
| 13 | 925715 | OTHER | PENNSYLVANIA | BLUE SHIELD |
| 14 | 925716 | OTHER | PENNSYLVANIA | BUE SHIELD |