Provider Demographics
NPI:1649371741
Name:PINE, GINA (LICSW)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:PINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:BREGGIA-PINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:479 NEW MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-2738
Mailing Address - Country:US
Mailing Address - Phone:401-944-2270
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ STE 130C
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5155
Practice Address - Country:US
Practice Address - Phone:401-944-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW011821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2278859OtherCIGNA BEHAVIORAL HEALTH
RI62-93351OtherUNITED BEHAVIORAL HEALTH
RI413316OtherBLUE CHIP PRODUCTS
RI31180-9OtherBLUE CROSS/BLUE SHIELD