Provider Demographics
NPI:1972541704
Name:MCCARTHY, TIMOTHY J (PHD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 NORMANDALE LAKE BLVD
Mailing Address - Street 2:SUITE 920
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1085
Mailing Address - Country:US
Mailing Address - Phone:952-921-8248
Mailing Address - Fax:
Practice Address - Street 1:8400 NORMANDALE LAKE BLVD
Practice Address - Street 2:SUITE 920
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1085
Practice Address - Country:US
Practice Address - Phone:952-921-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2386103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN26773MCOtherBLUECROSS
MN875-001OtherPREFERREDONE
MN61-20100OtherUBH
MN680000117Medicare ID - Type UnspecifiedMEDICARE