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 | | | No |
| 2 | 103TB0200X | Psychologist | Cognitive & Behavioral | | | No |
| 3 | 103TC0700X | Psychologist | Clinical | | | No |
| 4 | 103TM1800X | Psychologist | Intellectual and Developmental Disabilities | | | No |
| 5 | 104100000X | Social Worker | | | | No |
| 6 | 1041C0700X | Social Worker | Clinical | | | No |
| 7 | 2084P0805X | Psychiatry & Neurology | Geriatric Psychiatry | | | No |
| 8 | 2251G0304X | Physical Therapist | Geriatrics | | | No |
| 9 | 225X00000X | Occupational Therapist | | | | No |
| 10 | 225XG0600X | Occupational Therapist | Gerontology | | | No |
| 11 | 2355S0801X | Specialist/Technologist | Speech-Language Assistant | | | No |
| 12 | 207QG0300X | Family Medicine | Geriatric Medicine | | | Yes |