Provider Demographics
NPI:1538381520
Name:TATE, LEA KRISTEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEA
Middle Name:KRISTEN
Last Name:TATE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39400 PASEO PADRE PKWY
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2310
Mailing Address - Country:US
Mailing Address - Phone:510-248-5234
Mailing Address - Fax:
Practice Address - Street 1:39400 PASEO PADRE PKWY
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2310
Practice Address - Country:US
Practice Address - Phone:510-248-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19581103TC0700X
WAPY3394103TC0700X
VI06-023-PSY103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical