Provider Demographics
NPI:1619135290
Name:BOBB, VANESSA TONEY (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:TONEY
Last Name:BOBB
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CARLTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2285
Mailing Address - Country:US
Mailing Address - Phone:917-723-0546
Mailing Address - Fax:
Practice Address - Street 1:77 CARLTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2285
Practice Address - Country:US
Practice Address - Phone:917-723-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2471572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry