Provider Demographics
NPI:1124828686
Name:LIVINGSTON, TIM JOSEPH
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:JOSEPH
Last Name:LIVINGSTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BUTTERCUP LN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5723
Mailing Address - Country:US
Mailing Address - Phone:860-462-6494
Mailing Address - Fax:
Practice Address - Street 1:35 NUTMEG DR STE 102
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5495
Practice Address - Country:US
Practice Address - Phone:860-462-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach