Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 190205221 | CA |
NPI | 1053983940 |
---|---|
Provider Name | Mark T Atkinson |
First Address | Rockport, MA 01966-2175 |
Second Address | Rockport, MA 01966-2175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |