Provider Demographics
NPI:1609216415
Name:CORMIER, TIMOTHY L (CADC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:CORMIER
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5943
Mailing Address - Country:US
Mailing Address - Phone:207-739-2644
Mailing Address - Fax:207-739-2467
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:ME
Practice Address - Zip Code:04257-1440
Practice Address - Country:US
Practice Address - Phone:207-364-1717
Practice Address - Fax:207-364-1718
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist