Provider Demographics
NPI:1649506031
Name:DOWLING, TIMOTHY J (LADC,LPC, MED)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:DOWLING
Suffix:
Gender:M
Credentials:LADC,LPC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PORTER AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1973
Mailing Address - Country:US
Mailing Address - Phone:203-720-0341
Mailing Address - Fax:203-723-0702
Practice Address - Street 1:35 PORTER AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-1973
Practice Address - Country:US
Practice Address - Phone:203-729-0341
Practice Address - Fax:203-723-0702
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCAC-5526101YA0400X
CT000983101YA0400X
CT2389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT109517OtherASCA
CT710051OtherICRC
CT0008401715OtherCEA
CT8196090621OtherEDUCATOR
CTC042012001650OtherCT SCHOOL COUNSELOR CERTIFICATE-068
CT634485OtherPSI CHI