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General NPI Number Information
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NPI Number | 1023209947
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Entity Type | Individual
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Provider Name | TIMOTHY JOHN HEITZMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 5520 PARK AVE SUITE 206
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City | TRUMBULL
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State | CT
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Zip | 06611-3463
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Country | US
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Telephone | 203-612-0908
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Fax |
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Provider Business Mailing Address
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Address Line | 282 HOMELAND ST
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City | FAIRFIELD
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State | CT
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Zip | 06825-1526
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Country | US
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Telephone | 203-612-0908
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 002674
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License Number State | CT
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