Provider Demographics
NPI:1871694232
Name:OSTRICH, TIMOTHY MICHAEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:OSTRICH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 OLD ROUTE 119 HWY N
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1372
Mailing Address - Country:US
Mailing Address - Phone:724-465-5576
Mailing Address - Fax:
Practice Address - Street 1:793 OLD ROUTE 119 HWY N
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1372
Practice Address - Country:US
Practice Address - Phone:724-465-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042242A103TC0700X
PAPS017050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical