Provider Demographics
NPI:1194783647
Name:CAUFIELD, TIMOTHY GEORGE (PSCYHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GEORGE
Last Name:CAUFIELD
Suffix:
Gender:M
Credentials:PSCYHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1920
Mailing Address - Country:US
Mailing Address - Phone:262-767-8667
Mailing Address - Fax:262-767-8798
Practice Address - Street 1:209 N DODGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1920
Practice Address - Country:US
Practice Address - Phone:262-767-8667
Practice Address - Fax:262-767-8798
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1329057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39076700Medicaid
WI1329057OtherPSYCHOLOGIST
WI1329057OtherPSYCHOLOGIST
R54497Medicare UPIN