Timmothy Nelson Tillotson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW0004306 Issued in FL

Practice address

4850 A1A S
St Augustine, FL 32080-7447

Phone

(904) 377-7431

NPI assigned

Jan 22, 2007

Last updated

Sep 29, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411948800000",
    "number": "1336293836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 A1A S",
            "address_2": "UNIT #92",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320807447",
            "telephone_number": "904-377-7431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 A1A S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320807447",
            "telephone_number": "904-377-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLOTSON",
        "first_name": "TIMMOTHY",
        "middle_name": "NELSON",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2014-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW0004306",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "SW00296",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.