Provider Demographics
NPI:1366815664
Name:MINAROVIC, TIMOTHY (PHD, BSL)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MINAROVIC
Suffix:
Gender:M
Credentials:PHD, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1323
Mailing Address - Country:US
Mailing Address - Phone:610-944-0445
Mailing Address - Fax:610-944-8834
Practice Address - Street 1:90 S COMMERCE WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8601
Practice Address - Country:US
Practice Address - Phone:610-691-8401
Practice Address - Fax:610-691-0647
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001699261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)