Provider Demographics
NPI:1548291974
Name:STRONGIN, TIMOTHY (PHD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:STRONGIN
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 1:1101 MEDICAL ARTS AVE. BLDG.3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-247-1851
Mailing Address - Fax:505-247-2397
Practice Address - Street 1:2340 ALAMO AVE SE STE 123
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3523
Practice Address - Country:US
Practice Address - Phone:505-212-7000
Practice Address - Fax:505-212-7001
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM431103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000N0476Medicaid
343716305Medicare PIN