Provider Demographics
NPI:1568538866
Name:HUBER, TIMOTHY DUANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DUANE
Last Name:HUBER
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 1:1031 POST RD
Mailing Address - Street 2:STE 3
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4543
Mailing Address - Country:US
Mailing Address - Phone:203-915-5409
Mailing Address - Fax:
Practice Address - Street 1:1031 POST RD
Practice Address - Street 2:STE 3
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4543
Practice Address - Country:US
Practice Address - Phone:203-915-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2049103TC0700X
CA20497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002049CT01Medicare UPIN
CT0600012657Medicare ID - Type Unspecified
CAOPL204970Medicare PIN