Doctor Name: | DR. ROGER KENNETH LIGHT |
NPI Number: | 1992924047 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PSY819 |
Business Practice Address: | 509 N Sepulveda Blvd Suite 204 Manhattan Beach, CA - 902666746 |
Business Phone Number: | 3103741221 |
Business Fax Number: | 3102140648 |
Mailing Address: | 509 N Sepulveda Blvd, Suite 204 MANHATTAN BEACH |
State: | CA |
Postal Code: | 902666746 |
Phone Number: | 3103741221 |
Fax Number: | 3102140648 |
NPI Enumeration Date: | 04/25/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | PSY819 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | HI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |