Provider Demographics
NPI:1114395613
Name:TOBIN, DONNA LOUISE (CADC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LOUISE
Last Name:TOBIN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OCEAN ST
Mailing Address - Street 2:FL 2
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3517
Mailing Address - Country:US
Mailing Address - Phone:508-717-4559
Mailing Address - Fax:774-202-1931
Practice Address - Street 1:22 OCEAN ST
Practice Address - Street 2:FL 2
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3517
Practice Address - Country:US
Practice Address - Phone:508-717-4559
Practice Address - Fax:774-202-1931
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1620-AD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)