MEDICARE: MR. TIMOTHY B TOBIN II PSYD MA LCMHC LPC

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	101Y00000X	Counselor	3419076004	UT
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		MN
3	101YM0800X	Mental Health Counselor	PC006940	PA
4	101Y00000X	Counselor	641	NH

General Provider Information

NPI Number	:	1467578021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY B TOBIN II PSYD MA LCMHC LPC

Provider Business Mailing Address
First Line	:	165 VILLAGE CIRCLE WAY
Second Line	:	#3
City	:	MANCHESTER
State	:	NH
Zip	:	03102
Country	:	US
Telephone Number	:	603-398-3477
Fax Number	:

Provider Business Practice Location Address
First Line	:	FORT DRUM
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13603
Country	:	US
Telephone Number	:	315-772-3301
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/10/2025

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