Provider Demographics
NPI:1265425979
Name:RE, TIMOTHY JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:RE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 FAIRWAY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9758
Mailing Address - Country:US
Mailing Address - Phone:847-854-1340
Mailing Address - Fax:847-658-0787
Practice Address - Street 1:919 N PLUM GROVE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5144
Practice Address - Country:US
Practice Address - Phone:847-413-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL73274Medicare UPIN
IL556950Medicare PIN