MEDICARE: MS. DIANE MARY TOBIN MA,NCC,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	101YM0800X	Mental Health Counselor	03385117	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24000150CT01	OTHER	CT	ANTHEM BLUE CROSS & SHIEL

General Provider Information

NPI Number	:	1972711109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE MARY TOBIN MA,NCC,LPC

Provider Business Mailing Address
First Line	:	308 HIGHFIELD DR
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-5827
Country	:	US
Telephone Number	:	860-485-4245
Fax Number	:	860-482-0737

Provider Business Practice Location Address
First Line	:	50 ALBANY TPKE BLDG 5 FLOOR 2
Second Line	:
City	:	CANTON
State	:	CT
Zip	:	06019-2516
Country	:	US
Telephone Number	:	860-485-4245
Fax Number	:	860-482-0737

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	07/08/2007

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