Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 013205 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 013205 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 013205 | NY |
Y | 103G00000X | Clinical Psychologist | 013205 | NY |
Y | 103TC0700X | Clinical Psychologist | 013205 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 013204 | NY |
N | 103TM1800X | Intellectual & Developmental Disabilities | 013205 | NY |
NPI | 1811196579 |
---|---|
Provider Name | Dr. James Nelson Bowers Dillard |
First Address | New York, NY 10025-2666 |
Second Address | New York, NY 10025-2666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013205 | PSYCHOLOGY LICENSE STATE (01) | NY |