Provider Demographics
NPI:1417181850
Name:TATE, ANTOINETTE COOPER (PHD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:COOPER
Last Name:TATE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E MAIN ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3058
Mailing Address - Country:US
Mailing Address - Phone:856-722-9043
Mailing Address - Fax:856-727-1715
Practice Address - Street 1:720 E MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3058
Practice Address - Country:US
Practice Address - Phone:856-722-9043
Practice Address - Fax:856-727-1715
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ35SI00544600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health