Provider Demographics
NPI:1124007018
Name:LOBBY, THEODORE EDWARD (MSW)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:EDWARD
Last Name:LOBBY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2764
Mailing Address - Country:US
Mailing Address - Phone:952-929-6584
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S
Practice Address - Street 2:472
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1805
Practice Address - Country:US
Practice Address - Phone:952-922-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical