Provider Demographics
NPI:1033292271
Name:PINE, TINA (LISW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:PINE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3818
Mailing Address - Country:US
Mailing Address - Phone:419-425-5050
Mailing Address - Fax:419-423-6464
Practice Address - Street 1:1918 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3818
Practice Address - Country:US
Practice Address - Phone:419-425-5050
Practice Address - Fax:419-423-6464
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0004602104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW23102Medicare ID - Type Unspecified