Healthcare Provider Details

I. General information

NPI: 1417170853
Provider Name (Legal Business Name): SANDI TOBIN LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ROUTE 17 NORTH SUITE 313
PARAMUS NJ
07652
US

IV. Provider business mailing address

PO BOX 9094
PARAMUS NJ
07653-9094
US

V. Phone/Fax

Practice location:
  • Phone: 201-527-0351
  • Fax: 914-682-3755
Mailing address:
  • Phone: 201-527-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04716600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. SANDRA TOBIN
Title or Position: OWNER
Credential: LCSW
Phone: 201-527-0351