Provider Demographics
NPI:1972674356
Name:REDMAN, TIMOTHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:REDMAN
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 1:3344 BAHIA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7386
Mailing Address - Country:US
Mailing Address - Phone:941-951-0343
Mailing Address - Fax:941-803-2817
Practice Address - Street 1:3344 BAHIA VISTA ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7386
Practice Address - Country:US
Practice Address - Phone:941-951-0343
Practice Address - Fax:941-803-2817
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003846103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04652OtherBLUE CROSS BLUE SHIELD
FL75980OtherBLUE CROSS BLUE SHIELD
NC6000925Medicaid
NC2823571Medicare PIN