Provider Demographics
NPI:1023147550
Name:MCFADDEN, TIMOTHY C (PHD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:MCFADDEN
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 1:7 LEAVITT ST
Mailing Address - Street 2:PO BOX 928
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1805
Mailing Address - Country:US
Mailing Address - Phone:207-474-7190
Mailing Address - Fax:207-474-7117
Practice Address - Street 1:7 LEAVITT ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1805
Practice Address - Country:US
Practice Address - Phone:207-474-7190
Practice Address - Fax:207-474-7117
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS685103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME017237OtherANTHEM BLUE CROSS
ME2205772OtherAETNA PROVIDER NUMBER
ME2205772OtherAETNA PROVIDER NUMBER