Provider Demographics
NPI:1952726481
Name:BOBBITT, THERESA M (CASAC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:M
Last Name:BOBBITT
Suffix:
Gender:F
Credentials:CASAC
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Mailing Address - Street 1:1683 UNIVERSITY AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6910
Mailing Address - Country:US
Mailing Address - Phone:718-517-7934
Mailing Address - Fax:347-510-3455
Practice Address - Street 1:2976 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2822
Practice Address - Country:US
Practice Address - Phone:212-691-7554
Practice Address - Fax:347-510-3455
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY21424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21424OtherOFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES