Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1248 | NM |
N | 103T00000X | Psychologist | 1248 | NM |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1248 | NM |
N | 103TA0700X | Adult Development & Aging Psychologist | 1248 | NM |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1248 | NM |
N | 103G00000X | Clinical Psychologist | 1248 | NM |
N | 103TC0700X | Clinical Psychologist | 1248 | NM |
N | 103TC1900X | Counseling Psychologist | 1248 | NM |
N | 103TE1100X | Exercise & Sports Psychologist | 1248 | NM |
N | 103TF0000X | Family Psychologist | 1248 | NM |
N | 103TF0200X | Forensic Psychologist | 1248 | NM |
N | 103TH0004X | Health Psychologist | 1248 | NM |
N | 103TH0100X | Health Service | 1248 | NM |
N | 103TM1800X | Intellectual & Developmental Disabilities | 1248 | NM |
Y | 103TP0016X | Prescribing (Medical) | 0037 | NM |
N | 103TP2701X | Group Psychotherapist | 1248 | NM |
NPI | 1144351586 |
---|---|
Provider Name | Dr. Robert S. Chang |
First Address | Albuquerque, NM 87106-2725 |
Second Address | Albuquerque, NM 87106-2725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 02/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0037 | PRESCRIBING PSYCHOLOGIST (01) | NM |
1248 | NEW MEXICO STATE BOARD OF PSYCHOLOGIST EXAMINER (01) | NM |