Basic Information
| Provider Information | |||||||||
| NPI: | 1215261961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALVIN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD, CAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 EAGLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | EAGLEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194031829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106357594 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 EAGLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | EAGLEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194031829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106357594 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2009 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 103TC0700X | PS017320 | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.