Provider Demographics
NPI:1467075879
Name:TOBON, QUINCY M
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:M
Last Name:TOBON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 W SANDPIPER DR APT 8
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-2479
Mailing Address - Country:US
Mailing Address - Phone:561-781-1369
Mailing Address - Fax:
Practice Address - Street 1:8208 GARDEN CATALINA CIR APT 1914
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6765
Practice Address - Country:US
Practice Address - Phone:561-403-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-80128106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102259100Medicaid