Healthcare Provider Details

I. General information

NPI: 1811812688
Provider Name (Legal Business Name): KRISTEN TOBIASON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 W MAIN ST
ILION NY
13357-1531
US

IV. Provider business mailing address

11 HIGH ST
ILION NY
13357-1813
US

V. Phone/Fax

Practice location:
  • Phone: 315-570-3559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: