Provider Demographics
NPI:1841230315
Name:PISCOPINK, ANN MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:PISCOPINK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAADC
Mailing Address - Street 1:1814 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PENROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81240-9012
Mailing Address - Country:US
Mailing Address - Phone:719-784-7626
Mailing Address - Fax:
Practice Address - Street 1:1852 IRWIN DR BLDG 1059
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4176
Practice Address - Country:US
Practice Address - Phone:719-524-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68010636161041C0700X
MI68010636161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801063616OtherSTATE LICENSE
MI1-00185OtherCAC-I
MIAE063616Other3RD PARTY IDENTIFIER
MIAE063616Other3RD PARTY IDENTIFIER