A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974).
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Health Service | 103TH0100X |
| Clinical | 103TC0700X |
* Indicates primary specialty
| NPI Number | 1194808014 |
| Credentials | PSY.D. (Doctor of Psychology) |
| Entity | Individual |
| Enumeration date | 10/23/2006 |
| Last updated | 09/11/2025 - About 9 months ago |
| Sole proprietor1 | Yes |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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