Provider Demographics
NPI:1679742886
Name:TOBIN, MARC JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JAY
Last Name:TOBIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 FOUNTAIN ST
Mailing Address - Street 2:B3
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1847
Mailing Address - Country:US
Mailing Address - Phone:203-376-3776
Mailing Address - Fax:203-397-4919
Practice Address - Street 1:22 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4542
Practice Address - Country:US
Practice Address - Phone:203-376-3776
Practice Address - Fax:203-397-4919
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical