Provider Demographics
NPI:1265989644
Name:TW TIMMEL LLC
Entity type:Organization
Organization Name:TW TIMMEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-313-3986
Mailing Address - Street 1:7 BRISTLE LANE
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1476
Mailing Address - Country:US
Mailing Address - Phone:203-313-3986
Mailing Address - Fax:203-426-8947
Practice Address - Street 1:107 CHURCH HILL RD.
Practice Address - Street 2:SUITE 1
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1194
Practice Address - Country:US
Practice Address - Phone:203-313-3986
Practice Address - Fax:203-426-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0074621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty