Provider Demographics
NPI:1366889347
Name:TOBIN, KELLY M (LMHC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:TOBIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:210 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1010
Mailing Address - Country:US
Mailing Address - Phone:518-580-0520
Mailing Address - Fax:
Practice Address - Street 1:210 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1010
Practice Address - Country:US
Practice Address - Phone:518-580-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004534-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health