Provider Demographics
NPI:1417726407
Name:PRIVITERA, TIMOTHY SEAN
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SEAN
Last Name:PRIVITERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 S 185TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-6562
Mailing Address - Country:US
Mailing Address - Phone:402-813-1727
Mailing Address - Fax:
Practice Address - Street 1:11218 ELM ST STE B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4745
Practice Address - Country:US
Practice Address - Phone:531-375-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health