Healthcare Provider Details

I. General information

NPI: 1558431049
Provider Name (Legal Business Name): DAWN MARIE TOBOIKA LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 GOLDEN HILL LN
KINGSTON NY
12401-6441
US

IV. Provider business mailing address

2104 STATE ROUTE 32
KINGSTON NY
12401-8557
US

V. Phone/Fax

Practice location:
  • Phone: 845-340-4119
  • Fax: 845-340-4094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069552-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: