Provider Demographics
NPI:1093813909
Name:MCDADE, PETER I (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MCDADE
Suffix:I
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:M
Other - Last Name:MCDADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4180 LA JOLLA VILLAGE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1402
Mailing Address - Country:US
Mailing Address - Phone:619-515-4520
Mailing Address - Fax:
Practice Address - Street 1:4180 LA JOLLA VILLAGE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1402
Practice Address - Country:US
Practice Address - Phone:619-515-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical