Basic Information
| Provider Information | |||||||||
| NPI: | 1437504933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOBEN | ||||||||
| FirstName: | BLAKE | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1526 WALDEN AVE | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168956700 | ||||||||
| FaxNumber: | 7168960318 | ||||||||
| Practice Location | |||||||||
| Address1: | 5360 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | BOWMANSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140261044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166815077 | ||||||||
| FaxNumber: | 7166815079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2016 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 096764 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.