Healthcare Provider Details

I. General information

NPI: 1588795819
Provider Name (Legal Business Name): TIMOTHY P PEARMAN PHD, ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRENTICE WOMENS HOSPITAL 250 E. SUPERIOR, SUITE 520
CHICAGO IL
60611
US

IV. Provider business mailing address

633 N SAINT CLAIR ST STE 19-067
CHICAGO IL
60611-3234
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0990
  • Fax:
Mailing address:
  • Phone: 312-503-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number810
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: