Provider Demographics
NPI:1396020442
Name:LINEAWEAVER, TOBY (LMHC)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:
Last Name:LINEAWEAVER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:WOODS HOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02543-0677
Mailing Address - Country:US
Mailing Address - Phone:508-274-2448
Mailing Address - Fax:
Practice Address - Street 1:410 WOODS HOLE RD
Practice Address - Street 2:
Practice Address - City:WOODS HOLE
Practice Address - State:MA
Practice Address - Zip Code:02543-1523
Practice Address - Country:US
Practice Address - Phone:508-274-2448
Practice Address - Fax:866-437-5208
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health