Provider Demographics
NPI:1104981828
Name:TOBIN, DAVID LEWIS (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEWIS
Last Name:TOBIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MAPLE ST STE 401
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2208
Mailing Address - Country:US
Mailing Address - Phone:413-732-1717
Mailing Address - Fax:413-732-5155
Practice Address - Street 1:120 MAPLE ST STE 401
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2208
Practice Address - Country:US
Practice Address - Phone:413-732-1717
Practice Address - Fax:413-732-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6245103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1858955Medicaid
MA1858955Medicaid
MAW50307Medicare ID - Type Unspecified