Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 27474 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 27474 | CA |
Y | 103G00000X | Clinical Psychologist | 27474 | CA |
Y | 103TC0700X | Clinical Psychologist | 27474 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 27474 | CA |
N | 103TH0004X | Health Psychologist | 27474 | CA |
N | 103TH0100X | Health Service | 27474 | CA |
N | 103TP2701X | Group Psychotherapist | 27474 | CA |
NPI | 1720450638 |
---|---|
Provider Name | Dr. Nicholas Anderson |
First Address | Los Angeles, CA 90064-3946 |
Second Address | Los Angeles, CA 90064-3946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2015 |
Last Update Date | 30/10/2015 |