Provider Demographics
NPI:1588795819
Name:PEARMAN, TIMOTHY P (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:PEARMAN
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 N SAINT CLAIR ST STE 19-067
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3234
Mailing Address - Country:US
Mailing Address - Phone:312-503-7709
Mailing Address - Fax:
Practice Address - Street 1:PRENTICE WOMENS HOSPITAL
Practice Address - Street 2:250 E. SUPERIOR, SUITE 520
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA810103TC0700X
IL071008150103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942384Medicaid
MS0123722Medicaid
LA1106429Medicaid