Active NPI
Timothy B Tobin II, PSYD MA LCMHC LPC
- Counselor
- Watertown, NY
National Provider Identifier
1467578021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 641
- Practice address
- Fort Drum
Watertown, NY 13603 - Phone
- (315) 772-3301
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 3419076004 | UT | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | MN | ||
| Mental Health Counselor | 101YM0800X | PC006940 | PA | |
| Counselor | 101Y00000X | 641 | NH | Primary |
Addresses
Primary practice location
Fort Drum
Watertown, NY 13603
Mailing address
165 Village Circle Way
#3
Manchester, NH 03102
Phone (603) 398-3477
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 |
|---|---|---|---|
| 3419076004 | UT | MD | Counselor |
| PC006940 | PA | MD | Mental Health Counselor |
| 641 | NH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736467200000",
"number": "1467578021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 VILLAGE CIRCLE WAY",
"address_2": "#3",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "03102",
"telephone_number": "603-398-3477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "FORT DRUM",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "13603",
"telephone_number": "315-772-3301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOBIN",
"first_name": "TIMOTHY",
"middle_name": "B",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "PSYD MA LCMHC LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2025-01-10",
"certification_date": "2025-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "UT",
"license": "3419076004",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "PA",
"license": "PC006940",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NH",
"license": "641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.