Provider Demographics
NPI:1548201924
Name:PINE, REBECCA H (LICSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:H
Last Name:PINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:PINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:100 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1355
Mailing Address - Country:US
Mailing Address - Phone:978-448-2710
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1355
Practice Address - Country:US
Practice Address - Phone:978-448-8700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10232171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical