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NPI Profile for STATE OF DELAWARE in DOVER, DE.
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 | Specialty Code | Provider Type | |
Health Service |
103TH0100X | 62 | Psychologist, Clinical |
| NPI Number | 1306918180 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 11/15/2006 | |
| Last updated | 12/01/2011 - About 15 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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STATE OF DELAWARE
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STATE OF DELAWARE