Provider Demographics
NPI:1770113961
Name:KUMNICK, TIMOTHY NOLAN (MED, BCBA, LBA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:NOLAN
Last Name:KUMNICK
Suffix:
Gender:M
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2310
Mailing Address - Country:US
Mailing Address - Phone:860-680-6114
Mailing Address - Fax:
Practice Address - Street 1:86 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2310
Practice Address - Country:US
Practice Address - Phone:860-680-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT88103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst