Provider Demographics
NPI:1013107390
Name:TIMM, FREDERICK ROBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:ROBERT
Last Name:TIMM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 14TH ST
Mailing Address - Street 2:5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3012
Mailing Address - Country:US
Mailing Address - Phone:212-677-9792
Mailing Address - Fax:
Practice Address - Street 1:50 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5205
Practice Address - Country:US
Practice Address - Phone:212-989-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0790851041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health