Provider Demographics
NPI:1851505259
Name:TATE, BERNADETTE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:M
Last Name:TATE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 FISHERS RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3532
Mailing Address - Country:US
Mailing Address - Phone:610-525-8253
Mailing Address - Fax:
Practice Address - Street 1:168 FISHERS RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3532
Practice Address - Country:US
Practice Address - Phone:610-525-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health