Healthcare Provider Details

I. General information

NPI: 1245736198
Provider Name (Legal Business Name): LARA TOBIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BUCK BROOK RD
ROSCOE NY
12776-5624
US

IV. Provider business mailing address

447 BUCK BROOK RD
ROSCOE NY
12776-5624
US

V. Phone/Fax

Practice location:
  • Phone: 718-809-7889
  • Fax:
Mailing address:
  • Phone: 718-809-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number095263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: