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 | LCSW SC06014 | NEW JERSEY | No |
| 2 | 101YM0800X | Counselor | Mental Health | LCSW R033920-1 | NEW YORK | 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 | 0006950 | OTHER | NEW YORK | GHI PIN# |
| 2 | 72378297 | OTHER | NEW YORK | UNITED HEALTHCARE UID |
| 3 | 167974 | OTHER | NEW YORK | MENTAL HEALTH NETWORK |
| 4 | N96651 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 5 | P1296544 | OTHER | NEW YORK | OXFORD PROVIDER |
| 6 | 135522 | OTHER | NEW YORK | VALUE OPTIONS MHS PROVIDE |
