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NPI Code Detail

MEDICARE: DR. KRISTIN JOHNSON DINATALE PSY.D.

MEDICARE: DR. KRISTIN JOHNSON DINATALE PSY.D.
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 Psychologist002522CT

General Provider Information

NPI Number : 1770744864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIN JOHNSON DINATALE PSY.D.
Provider Business Mailing Address
First Line : 350 CENTER ST
Second Line : SUITE 207
City : WALLINGFORD
State : CT
Zip : 06492-4243
Country : US
Telephone Number : 203-269-2355
Fax Number : 203-269-2357
Provider Business Practice Location Address
First Line : 350 CENTER ST
Second Line : SUITE 207
City : WALLINGFORD
State : CT
Zip : 06492-4243
Country : US
Telephone Number : 203-269-2355
Fax Number : 203-269-2357
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2008
Last Update Date : 06/20/2008

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