Healthcare Provider Details

I. General information

NPI: 1386733285
Provider Name (Legal Business Name): TOBY L TOBIAS LCSW PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 COLUMBUS DR
SOUTH HUNTINGTON NY
11746-2734
US

IV. Provider business mailing address

23 COLUMBUS DR
SOUTH HUNTINGTON NY
11746-2734
US

V. Phone/Fax

Practice location:
  • Phone: 631-424-1690
  • Fax: 631-424-1084
Mailing address:
  • Phone: 631-424-1690
  • Fax: 631-424-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR033972-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: