Healthcare Provider Details

I. General information

NPI: 1194783647
Provider Name (Legal Business Name): TIMOTHY GEORGE CAUFIELD PSCYHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N DODGE ST
BURLINGTON WI
53105-1920
US

IV. Provider business mailing address

209 N DODGE ST
BURLINGTON WI
53105-1920
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-8667
  • Fax: 262-767-8798
Mailing address:
  • Phone: 262-767-8667
  • Fax: 262-767-8798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1329057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: