Provider Demographics
NPI:1396895454
Name:MCMANUS, TIMOTHY DONALD (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DONALD
Last Name:MCMANUS
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 1:8210 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1845
Mailing Address - Country:US
Mailing Address - Phone:708-917-0088
Mailing Address - Fax:708-915-4023
Practice Address - Street 1:INGALLS HOSPITAL ACUTE REHABILITATION UNIT
Practice Address - Street 2:ONE INGALLS DR.
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-9988
Practice Address - Country:US
Practice Address - Phone:708-915-4237
Practice Address - Fax:708-915-4023
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103G00000X, 103TC0700X, 103TH0004X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2207287OtherBLUE CROSS BLUE SHIELD
IL343540Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST