Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY19475 | CA |
Y | 103G00000X | Clinical Psychologist | PSY19475 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY19475 | CA |
N | 103TH0004X | Health Psychologist | PSY19475 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY19475 | CA |
NPI | 1447488127 |
---|---|
Provider Name | Dr. Timothy J Worden |
First Address | Santa Rosa, CA 95401-4658 |
Second Address | Santa Rosa, CA 95401-4658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 18/08/2017 |