MEDICARE: DR. TERRY R. TOBIAS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	4124	OH

General Provider Information

NPI Number	:	1033202973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY R. TOBIAS PH.D.

Provider Business Mailing Address
First Line	:	12429 CEDAR ROAD SUITE 16
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-791-8009
Fax Number	:	216-791-8013

Provider Business Practice Location Address
First Line	:	12429 CEDAR ROAD SUITE 16
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-791-8009
Fax Number	:	216-791-8013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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