Doctor Name: | THEODORE TIMMEL |
NPI Number: | 1619308905 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 007462 |
Business Practice Address: | 107 Church Hill Rd Sandy Hook, CT - 064821194 |
Business Phone Number: | 2032709888 |
Business Fax Number: | |
Mailing Address: | 14-3 Arrowhead Way, WOODBURY |
State: | CT |
Postal Code: | 067982022 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/11/2013 |
NPI Last Update Date: | 12/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 007462 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |