Provider Demographics
NPI:1194472522
Name:AQUINO, TIMOTHY M (LMFT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:AQUINO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3040
Mailing Address - Country:US
Mailing Address - Phone:203-208-3940
Mailing Address - Fax:203-693-4900
Practice Address - Street 1:19 LUDLOW RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3040
Practice Address - Country:US
Practice Address - Phone:203-208-3940
Practice Address - Fax:203-693-4900
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008107193Medicaid