Healthcare Provider Details

I. General information

NPI: 1457682122
Provider Name (Legal Business Name): R. TIMOTHY CONNORS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 RED OAK ST
PAXTON MA
01612-1267
US

IV. Provider business mailing address

PO BOX 25
HOLDEN MA
01520-0025
US

V. Phone/Fax

Practice location:
  • Phone: 508-864-5218
  • Fax: 855-581-8051
Mailing address:
  • Phone: 508-831-7745
  • Fax: 855-581-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number322113
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9098
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: