Provider Demographics
NPI:1902438443
Name:MOONEY, TIMOTHY ALBERT II
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALBERT
Last Name:MOONEY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BOYLSTON LANE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-5589
Mailing Address - Country:US
Mailing Address - Phone:339-227-9133
Mailing Address - Fax:
Practice Address - Street 1:8 FANEUIL HALL MARKET PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-6114
Practice Address - Country:US
Practice Address - Phone:888-329-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician