1649506031 NPI number — MR. TIMOTHY J DOWLING LADC,LPC, M.ED.

Table of content: MR. TIMOTHY J DOWLING LADC,LPC, M.ED. (NPI 1649506031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649506031 NPI number — MR. TIMOTHY J DOWLING LADC,LPC, M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWLING
Provider First Name:
TIMOTHY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LADC,LPC, M.ED.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649506031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 PORTER AVE
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
NAUGATUCK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06770-1973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-720-0341
Provider Business Mailing Address Fax Number:
203-723-0702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 PORTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAUGATUCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06770-1973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-729-0341
Provider Business Practice Location Address Fax Number:
203-723-0702
Provider Enumeration Date:
10/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CAC-5526 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 000983 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2389 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109517 . This is a "ASCA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 710051 . This is a "ICRC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0008401715 . This is a "CEA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 8196090621 . This is a "EDUCATOR" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C042012001650 . This is a "CT SCHOOL COUNSELOR CERTIFICATE-068" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 634485 . This is a "PSI CHI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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