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 | 103TA0700X | Psychologist | Adult Development & Aging | PSY 9194 | CALIFORNIA | No |
| 2 | 103TR0400X | Psychologist | Rehabilitation | PSY 9194 | CALIFORNIA | No |
| 3 | 103G00000X | Clinical Neuropsychologist | | PSY 9194 | CALIFORNIA | Yes |