Provider Demographics
NPI:1457682122
Name:CONNORS, R. TIMOTHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:TIMOTHY
Last Name:CONNORS
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 1:23 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2126
Mailing Address - Country:US
Mailing Address - Phone:508-797-0537
Mailing Address - Fax:
Practice Address - Street 1:23 FRUIT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2126
Practice Address - Country:US
Practice Address - Phone:508-797-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9098103T00000X
MA322113103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool