| Name | Value |
|---|---|
| PROVIDER TYPE | Behavioral Health & Social Service Providers |
| CLASSIFICATION | Psychologist |
| DEFINITION | A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974). |
| AREA OF SPECIALIZATION | Health Service |
| STATUS | Active |
| VA CODE | V010407 |
| X12 CODE | 103TH0100X |
| SPECIALTY CODE | 62 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252357 |
| EFFECTIVE DATE/TIME |
|