Provider Demographics
NPI:1225175540
Name:DWYER, TIMOTHY F (PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:DWYER
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 1:1057 LINDEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2727
Mailing Address - Country:US
Mailing Address - Phone:504-232-0316
Mailing Address - Fax:
Practice Address - Street 1:618 LIBRARY PLACE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-733-4300
Practice Address - Fax:847-733-0390
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2051101Y00000X
MI4101006070106H00000X
LA7106H00000X
IL166.000694106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor