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NPI Code Detail

MEDICARE: TARA MCBRIDE AFONSO PSYD

MEDICARE: TARA MCBRIDE AFONSO PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1386NH

General Provider Information

NPI Number : 1558809335
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA MCBRIDE AFONSO PSYD
Provider Business Mailing Address
First Line : 55 HATCHETTS HILL RD
Second Line :
City : OLD LYME
State : CT
Zip : 06371-1534
Country : US
Telephone Number : 800-370-3651
Fax Number : 877-515-7147
Provider Business Practice Location Address
First Line : 10 FERRY ST STE 313
Second Line : MEDOPTIONS OF NEW HAMPSHIRE, LLC.
City : CONCORD
State : NH
Zip : 03301-5004
Country : US
Telephone Number : 800-370-3651
Fax Number : 877-515-7147
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2017
Last Update Date : 02/14/2017

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