Provider Demographics
NPI:1154714848
Name:DOROTHY TIMMERMANN
Entity type:Organization
Organization Name:DOROTHY TIMMERMANN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIMMERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-500-9011
Mailing Address - Street 1:324 ELM ST
Mailing Address - Street 2:SUITE 204B
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2280
Mailing Address - Country:US
Mailing Address - Phone:203-500-9011
Mailing Address - Fax:
Practice Address - Street 1:324 ELM ST
Practice Address - Street 2:SUITE 204B
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2280
Practice Address - Country:US
Practice Address - Phone:203-500-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty