Provider Demographics
NPI:1386733285
Name:TOBIAS, TOBY L (LCSW PHD)
Entity type:Individual
Prefix:
First Name:TOBY
Middle Name:L
Last Name:TOBIAS
Suffix:
Gender:M
Credentials:LCSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2734
Mailing Address - Country:US
Mailing Address - Phone:631-424-1690
Mailing Address - Fax:631-424-1084
Practice Address - Street 1:23 COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:SOUTH HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11746-2734
Practice Address - Country:US
Practice Address - Phone:631-424-1690
Practice Address - Fax:631-424-1084
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033972-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical