Healthcare Provider Details

I. General information

NPI: 1679679526
Provider Name (Legal Business Name): DONNA B TOBIN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 LOST NATION RD
WILLOUGHBY OH
44094-7375
US

IV. Provider business mailing address

30 E BROAD ST 11TH FLOOR
COLUMBUS OH
43215-3414
US

V. Phone/Fax

Practice location:
  • Phone: 440-550-9701
  • Fax: 440-953-0438
Mailing address:
  • Phone: 604-466-6583
  • Fax: 614-644-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0007787
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: