Provider Demographics
NPI:1508331059
Name:TOBIN, ABBY MAIRE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:MAIRE
Last Name:TOBIN
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CITYPLACE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7055
Mailing Address - Country:US
Mailing Address - Phone:314-626-0306
Mailing Address - Fax:314-272-3974
Practice Address - Street 1:2 CITYPLACE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7055
Practice Address - Country:US
Practice Address - Phone:314-626-0306
Practice Address - Fax:314-272-3974
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MO1-21-53461103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician