Healthcare Provider Details

I. General information

NPI: 1063421519
Provider Name (Legal Business Name): JUSTIN EVAN TOBIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E WASHINGTON ST SUITE 2700
CHICAGO IL
60602-2103
US

IV. Provider business mailing address

1637 W WINONA ST 2
CHICAGO IL
60640-2707
US

V. Phone/Fax

Practice location:
  • Phone: 773-308-3468
  • Fax:
Mailing address:
  • Phone: 773-308-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: