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 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 3 | 261QU0200X | Clinic/Center | Urgent Care | | | No |
| 4 | 261QX0100X | Clinic/Center | Occupational Medicine | | | No |
| 5 | 207R00000X | Internal Medicine | | | | Yes |