Provider Demographics
NPI:1740373075
Name:MONTAGNA-TATE, TINA M (MA, ATR-BC, LPC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:MONTAGNA-TATE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 STRAUBE CENTER BLVD
Mailing Address - Street 2:SUITE K-20/OFFICE 4
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1450
Mailing Address - Country:US
Mailing Address - Phone:609-818-0285
Mailing Address - Fax:
Practice Address - Street 1:114 STRAUBE CENTER BLVD
Practice Address - Street 2:SUITE K-20/OFFICE 4
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1450
Practice Address - Country:US
Practice Address - Phone:609-818-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC00311300101YP2500X
PA000625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional