Provider Demographics
NPI:1770744864
Name:DINATALE, KRISTIN JOHNSON (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:JOHNSON
Last Name:DINATALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CENTER ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4243
Mailing Address - Country:US
Mailing Address - Phone:203-269-2355
Mailing Address - Fax:203-269-2357
Practice Address - Street 1:350 CENTER ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4243
Practice Address - Country:US
Practice Address - Phone:203-269-2355
Practice Address - Fax:203-269-2357
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical