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 | 103T00000X | Psychologist | | 137 | MASSACHUSETTS | No |
| 2 | 101YM0800X | Counselor | Mental Health | 4428 | MASSACHUSETTS | 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 | 10671 | OTHER | MASSACHUSETTS | BCBS |
| 2 | 30010326 | MEDICAID | NEW HAMPSHIRE | |
| 3 | 307470 | OTHER | | MHN GROUP |
| 4 | 1549A | OTHER | NEW HAMPSHIRE | BEHAVIORAL HEALTH NETWORK |
| 5 | 91538 | OTHER | | AETNA |
| 6 | 9549A1 | OTHER | NEW HAMPSHIRE | ANTHEM BCBS |
| 7 | LMG015 | OTHER | MASSACHUSETTS | BCBS GROUP |
| 8 | 13700001 | OTHER | | PACIFICARE BEHAVIORAL HEA |
| 9 | 113309 | OTHER | | VALUE OPTIONS |
| 10 | 36655 | OTHER | | CIGNA |
| 11 | 627000 | OTHER | | MAGELLAN |
| 12 | 1239 | OTHER | | EMPIRE BCBS |
| 13 | 59310 | OTHER | MASSACHUSETTS | TUFTS ASSOC HEALTH PLAN |
| 14 | 613851 | OTHER | MASSACHUSETTS | TRUFTS GROUP |
| 15 | 85211 | OTHER | | MANAGED HEALTH NETWORK |
