Provider Demographics
NPI:1326341215
Name:PINES, JOYCE OBERMEYER (MA)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:OBERMEYER
Last Name:PINES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5464 HOLIDAY TER
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2147
Mailing Address - Country:US
Mailing Address - Phone:269-488-5905
Mailing Address - Fax:269-488-5906
Practice Address - Street 1:5464 HOLIDAY TER
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2147
Practice Address - Country:US
Practice Address - Phone:269-488-5905
Practice Address - Fax:269-488-5906
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP520447650254103T00000X
MI6301014740103TC1900X
MIC-02759101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)