Provider Demographics
NPI:1467578021
Name:TOBIN, TIMOTHY B II (MA, LCMHC, CAS)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:B
Last Name:TOBIN
Suffix:II
Gender:M
Credentials:MA, LCMHC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 VILLAGE CIRCLE WAY
Mailing Address - Street 2:#3
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:603-398-3477
Mailing Address - Fax:
Practice Address - Street 1:165 VILLAGE CIRCLE WAY
Practice Address - Street 2:#3
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102
Practice Address - Country:US
Practice Address - Phone:603-398-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH641101Y00000X
UT3419076004101Y00000X
MN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT101YM0800XOther3419076004
NH101YM0800XOther641