Provider Demographics
NPI:1093883449
Name:TATE, ROBERT JOHN II (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:TATE
Suffix:II
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3964
Mailing Address - Country:US
Mailing Address - Phone:207-773-0481
Mailing Address - Fax:207-541-4939
Practice Address - Street 1:38 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3964
Practice Address - Country:US
Practice Address - Phone:207-773-0481
Practice Address - Fax:207-541-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health