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 | | PSY 14203 | CALIFORNIA | No |
| 2 | 103TA0700X | Psychologist | Adult Development & Aging | PSY 14203 | CALIFORNIA | No |
| 3 | 103TB0200X | Psychologist | Cognitive & Behavioral | PSY 14203 | CALIFORNIA | No |
| 4 | 103TC0700X | Psychologist | Clinical | PSY 14203 | CALIFORNIA | No |
| 5 | 103TC1900X | Psychologist | Counseling | PSY 14203 | CALIFORNIA | No |
| 6 | 103TC2200X | Psychologist | Clinical Child & Adolescent | PSY 14203 | CALIFORNIA | No |
| 7 | 103TP2701X | Psychologist | Group Psychotherapy | PSY 14203 | CALIFORNIA | No |
| 8 | 104100000X | Social Worker | | LCS 8507 | CALIFORNIA | No |
| 9 | 1041C0700X | Social Worker | Clinical | LCS 8507 | CALIFORNIA | 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 | LCS 8507 | OTHER | CALIFORNIA | LCSW |
| 2 | PSY 14203 | OTHER | CALIFORNIA | PSYCHOLOGIST |