Individual
DR. TIMOTHY T. WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 390-3785
(904) 390-3512
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PY4811
FL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PY4811
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000546202A
—
GA
Enumeration date
08/10/2006
Last updated
09/02/2011
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