Healthcare Provider Details

I. General information

NPI: 1154489813
Provider Name (Legal Business Name): TIMOTHY FRANCIS DOWLING LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SCHUYLER ST
BOONVILLE NY
13309-1005
US

IV. Provider business mailing address

120 SCHUYLER ST
BOONVILLE NY
13309-1005
US

V. Phone/Fax

Practice location:
  • Phone: 315-942-4252
  • Fax: 315-942-3207
Mailing address:
  • Phone: 315-942-4252
  • Fax: 315-942-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0419181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: