MEDICARE: TOBY L TOBIAS LCSW PHD

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	1041C0700X	Clinical Social Worker	R033972-1	NY

General Provider Information

NPI Number	:	1386733285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOBY L TOBIAS LCSW PHD

Provider Business Mailing Address
First Line	:	23 COLUMBUS DR
Second Line	:
City	:	SOUTH HUNTINGTON
State	:	NY
Zip	:	11746-2734
Country	:	US
Telephone Number	:	631-424-1690
Fax Number	:	631-424-1084

Provider Business Practice Location Address
First Line	:	23 COLUMBUS DR
Second Line	:
City	:	SOUTH HUNTINGTON
State	:	NY
Zip	:	11746-2734
Country	:	US
Telephone Number	:	631-424-1690
Fax Number	:	631-424-1084

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	10/21/2009

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