Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810002005 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810002005 | VA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810002005 | VA |
N | 103TH0004X | Health Psychologist |
NPI | 1811135668 |
---|---|
Provider Name | Dr. Bruce Pickle |
First Address | Arlington, VA 22207-3807 |
Second Address | Arlington, VA 22207-3807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 02/02/2009 |