Provider Demographics
NPI:1972990521
Name:GANTZ, TOBY MARSHA (LMSW)
Entity type:Individual
Prefix:MS
First Name:TOBY
Middle Name:MARSHA
Last Name:GANTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TOBY
Other - Middle Name:MARSHA
Other - Last Name:GREENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1517 OREGON CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3368
Mailing Address - Country:US
Mailing Address - Phone:248-421-6346
Mailing Address - Fax:
Practice Address - Street 1:1517 OREGON CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-3368
Practice Address - Country:US
Practice Address - Phone:248-421-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010359031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical