Provider Demographics
NPI:1427303619
Name:TOBIN, MICHELLE MARY DILLAENE (MPS, MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARY DILLAENE
Last Name:TOBIN
Suffix:
Gender:F
Credentials:MPS, MSW, LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARY
Other - Last Name:DILLAENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPS
Mailing Address - Street 1:828 W. GORE ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509
Mailing Address - Country:US
Mailing Address - Phone:814-868-3535
Mailing Address - Fax:
Practice Address - Street 1:828 W. GORE ROAD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509
Practice Address - Country:US
Practice Address - Phone:814-868-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW016814104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker