Provider Demographics
NPI:1215023304
Name:DAY, TIMOTHY MCINTOSH (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MCINTOSH
Last Name:DAY
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 LYNDALE AVE S
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1309
Mailing Address - Country:US
Mailing Address - Phone:612-817-1700
Mailing Address - Fax:763-389-8511
Practice Address - Street 1:6173 COUNTY ROAD 6 NW
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-5315
Practice Address - Country:US
Practice Address - Phone:612-817-1700
Practice Address - Fax:763-389-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical