Provider Demographics
NPI:1063421519
Name:TOBIN, JUSTIN EVAN (LCSW)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:EVAN
Last Name:TOBIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 W WINONA ST
Mailing Address - Street 2:2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2707
Mailing Address - Country:US
Mailing Address - Phone:773-308-3468
Mailing Address - Fax:
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 2700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:773-308-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical