Provider Demographics
NPI:1194912824
Name:TOBY, DIANE PIES (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:PIES
Last Name:TOBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5007 LINCOLN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4187
Mailing Address - Country:US
Mailing Address - Phone:630-470-7921
Mailing Address - Fax:630-629-8048
Practice Address - Street 1:5007 LINCOLN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4187
Practice Address - Country:US
Practice Address - Phone:630-470-7921
Practice Address - Fax:630-629-8048
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007194103G00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12253092OtherCAQH
IL1194912824OtherNPI NUMBER
IL071007194OtherLICENSE (CLINICAL PSYCHOLOGIST)