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General NPI Number Information
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NPI Number | 1215283601
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Entity Type | Organization
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Legal Business Name | SUSAN L. TOBIN, LLC
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 5745 W MAPLE RD SUITE 213
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4468
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Country | US
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Telephone | 248-932-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 5447 POND BLUFF CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2441
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Country | US
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Telephone | 248-762-1247
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL SOCIAL WORKER
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Name | SUSAN L TOBIN
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Credential | MSW, LMSW
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Telephone | 248-762-1247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801090375
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License Number State | MI
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