Active NPI
Nicole Marie Tobin, R-LCSW
- Clinical Social Worker
- Port Jefferson, NY
National Provider Identifier
1093852691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 049172-1
- Practice address
- 905 Main St
Port Jefferson, NY 11777-2201 - Phone
- (631) 455-6951
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 049172-1 | NY | Primary |
Addresses
Primary practice location
905 Main St
Port Jefferson, NY 11777-2201
Mailing address
29 Three Sisters Rd
Saint James, NY 11780-1218
Phone (631) 455-6951
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049172-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093852691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 THREE SISTERS RD",
"city": "SAINT JAMES",
"state": "NY",
"postal_code": "117801218",
"telephone_number": "631-455-6951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 MAIN ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772201",
"telephone_number": "631-455-6951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOBIN",
"first_name": "NICOLE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "R-LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "049172-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.