Provider Demographics
NPI:1154489813
Name:DOWLING, TIMOTHY FRANCIS (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FRANCIS
Last Name:DOWLING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SCHUYLER ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-1005
Mailing Address - Country:US
Mailing Address - Phone:315-942-4252
Mailing Address - Fax:315-942-3207
Practice Address - Street 1:120 SCHUYLER ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-1005
Practice Address - Country:US
Practice Address - Phone:315-942-4252
Practice Address - Fax:315-942-3207
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04191811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55921DMedicare ID - Type Unspecified