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1 Richmond Sq Ste 130c Providence RI 02906-5155 | |
| (401) 944-2270 | |
| (401) 944-0026 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1 Richmond Sq Ste 130c, Providence, Rhode Island |
| Authorized Official Name and Position | Gina M Pine (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4019442270 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 165 Barrington RI 02806-0165 Ph: (401) 944-2270 | 1 Richmond Sq Ste 130c Providence RI 02906-5155 Ph: (401) 944-2270 |
| NPI Number | 1164613154 |
|---|---|
| Provider Enumeration Date | 08/06/2007 |
| Last Update Date | 10/17/2024 |
| Certification Date | 10/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164613154 | NPI | - | NPPES |
| 2278859 | Other | RI | CIGNA |
| 62-93351 | Other | RI | UNITED HEALTH |
| 31180-9 | Other | RI | BLUE CROSS |
| 413316 | Other | RI | BLUE CHIP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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