Provider Demographics
NPI:1902939135
Name:NANCE, TIMOTHY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:NANCE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BLOOMFIELD AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095
Mailing Address - Country:US
Mailing Address - Phone:860-683-2352
Mailing Address - Fax:860-219-1179
Practice Address - Street 1:61 BLOOMFIELD AVE
Practice Address - Street 2:FL 2
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095
Practice Address - Country:US
Practice Address - Phone:860-683-2352
Practice Address - Fax:860-219-1179
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001057103T00000X
NC1160103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT073409OtherVALUEOPTIONS
CT060001057CT01OtherANTHEM BCBS
CT060001057CT01OtherBLUE CROSS BLUE SHIELD
CT073409OtherVALUEOPTIONS