Provider Demographics
NPI:1154486462
Name:TATE, DAVID CARINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARINE
Last Name:TATE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3401
Mailing Address - Country:US
Mailing Address - Phone:203-627-6618
Mailing Address - Fax:203-624-7599
Practice Address - Street 1:357 WHITNEY AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2364
Practice Address - Country:US
Practice Address - Phone:203-627-6618
Practice Address - Fax:203-624-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2336103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical