MEDICARE: DR. DAVID CARINE TATE PH.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
1	103TC0700X	Clinical Psychologist	2336	CT

General Provider Information

NPI Number	:	1154486462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CARINE TATE PH.D.

Provider Business Mailing Address
First Line	:	2 BAYBERRY RD
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06517-3401
Country	:	US
Telephone Number	:	203-627-6618
Fax Number	:	203-624-7599

Provider Business Practice Location Address
First Line	:	357 WHITNEY AVE
Second Line	:	SUITE 303
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-2364
Country	:	US
Telephone Number	:	203-627-6618
Fax Number	:	203-624-7599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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