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NPI Code Detail

MEDICARE: DR. TIMOTHY J WORDEN PH.D.

MEDICARE: DR. TIMOTHY J WORDEN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0400XAddiction (Substance Use Disorder) PsychologistPSY19475CA
2103TH0004XHealth PsychologistPSY19475CA
3103TR0400XRehabilitation PsychologistPSY19475CA
4103TC0700XClinical PsychologistPSY19475CA

General Provider Information

NPI Number : 1447488127
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY J WORDEN PH.D.
Provider Business Mailing Address
First Line : 1160 N DUTTON AVE STE 230
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4658
Country : US
Telephone Number : 310-701-7058
Fax Number :
Provider Business Practice Location Address
First Line : 1160 N DUTTON AVE STE 230
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4658
Country : US
Telephone Number : 707-303-3201
Fax Number : 707-526-8310
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2009
Last Update Date : 07/21/2022

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