Behavioral Health & Social Service Providers (518) PERSON CLASS (8932.1)

Name	Value
PROVIDER TYPE	Behavioral Health & Social Service Providers
CLASSIFICATION	Psychologist
AREA OF SPECIALIZATION	Intellectual & Developmental Disabilities
STATUS	Active
VA CODE	V010415
X12 CODE	103TM1800X
SPECIALTY CODE	62
INDIVIDUAL/NON	INDIVIDUAL
MASTER ENTRY FOR VUID	YES
VUID	5252363
EFFECTIVE DATE/TIME	2018-04-02 15:35:52 STATUS: ACTIVE