Provider Demographics
NPI:1366865503
Name:VERMILLION, TIMOTHY (LCSW)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:VERMILLION
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 1:520 NE 20TH ST APT 1001
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2160
Mailing Address - Country:US
Mailing Address - Phone:754-226-6222
Mailing Address - Fax:
Practice Address - Street 1:520 NE 20TH ST APT 1001
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2160
Practice Address - Country:US
Practice Address - Phone:754-226-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055083001041C0700X
FL131571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical