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General NPI Number Information
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NPI Number | 1487294559
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Entity Type | Individual
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Provider Name | MR. TIMOTHY CLYNCH
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Gender | Male
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 03/30/2025
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Provider Practice Location Address
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Address Line | 27 MILL ST UNIT D
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City | QUINCY
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State | MA
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Zip | 02169-5656
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Country | US
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Telephone | 508-230-1752
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Fax |
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Provider Business Mailing Address
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Address Line | 625 THOMAS BURGIN PKWY APT 538
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City | QUINCY
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State | MA
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Zip | 02169-7658
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Country | US
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Telephone | 860-424-2623
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2304438
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 2304438
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License Number State | MA
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