Provider Demographics
NPI:1427356054
Name:HEAD, TINA KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:KAY
Last Name:HEAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:KAY
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:20 COUNTY ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-3130
Mailing Address - Country:US
Mailing Address - Phone:315-751-9777
Mailing Address - Fax:
Practice Address - Street 1:20 COUNTY ROUTE 37
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-3130
Practice Address - Country:US
Practice Address - Phone:315-751-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018995103T00000X, 103TA0700X, 103TC0700X, 103TC2200X, 103TF0000X, 103TM1800X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy