Provider Demographics
NPI:1558554840
Name:KLONSKY, TOBIN LEWIS (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:TOBIN
Middle Name:LEWIS
Last Name:KLONSKY
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2408
Mailing Address - Country:US
Mailing Address - Phone:510-465-1800
Mailing Address - Fax:510-465-1508
Practice Address - Street 1:2730 ADELINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2408
Practice Address - Country:US
Practice Address - Phone:510-465-1800
Practice Address - Fax:510-465-1508
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist