Provider Demographics
NPI:1316263734
Name:TOBIAS, MARK A (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:TOBIAS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4160
Mailing Address - Country:US
Mailing Address - Phone:914-576-3614
Mailing Address - Fax:914-576-0526
Practice Address - Street 1:420 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4160
Practice Address - Country:US
Practice Address - Phone:914-576-3614
Practice Address - Fax:914-576-0526
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032491-1283Q00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No283Q00000XHospitalsPsychiatric Hospital