Provider Demographics
NPI:1780745182
Name:MORAN, TIMOTHY O (LADC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:O
Last Name:MORAN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FLYNN AVE
Mailing Address - Street 2:3-J
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5429
Mailing Address - Country:US
Mailing Address - Phone:802-859-1230
Mailing Address - Fax:802-660-3665
Practice Address - Street 1:208 FLYNN AVE
Practice Address - Street 2:3-J
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5429
Practice Address - Country:US
Practice Address - Phone:802-859-1230
Practice Address - Fax:802-660-3665
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000170101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)