Provider Demographics
NPI:1124752522
Name:TOBIN, SUSAN F
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:TOBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FALLKILL PL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1804
Mailing Address - Country:US
Mailing Address - Phone:845-483-7051
Mailing Address - Fax:845-483-7052
Practice Address - Street 1:7 FALLKILL PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1804
Practice Address - Country:US
Practice Address - Phone:845-483-7051
Practice Address - Fax:845-483-7052
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28286101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)