Provider Demographics
NPI:1558809335
Name:AFONSO, TARA MCBRIDE (PSYD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MCBRIDE
Last Name:AFONSO
Suffix:
Gender:F
Credentials:PSYD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:55 HATCHETTS HILL RD
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1534
Mailing Address - Country:US
Mailing Address - Phone:800-370-3651
Mailing Address - Fax:877-515-7147
Practice Address - Street 1:10 FERRY ST STE 313
Practice Address - Street 2:MEDOPTIONS OF NEW HAMPSHIRE, LLC.
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5004
Practice Address - Country:US
Practice Address - Phone:800-370-3651
Practice Address - Fax:877-515-7147
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH1386103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical