Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 1290 | AL |
N | 103TC0700X | Clinical Psychologist | 1290 | AL |
N | 103TH0004X | Health Psychologist | 1290 | AL |
Y | 103TR0400X | Rehabilitation Psychologist | 1290 | AL |
NPI | 1225449309 |
---|---|
Provider Name | Dr. Gitendra Uswatte |
First Address | Birmingham, AL 35294-1170 |
Second Address | Birmingham, AL 35294-1170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 12/05/2014 |