Provider Demographics
NPI:1245736198
Name:TOBIN, LARA (LMSW)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:TOBIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E 2ND ST APT CC5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5622
Mailing Address - Country:US
Mailing Address - Phone:718-809-7889
Mailing Address - Fax:
Practice Address - Street 1:640 E 2ND ST APT CC5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5622
Practice Address - Country:US
Practice Address - Phone:718-809-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095263104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker