Provider Demographics
NPI:1972890572
Name:PINES, EMILY R (LCPC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:R
Last Name:PINES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3047
Mailing Address - Country:US
Mailing Address - Phone:207-332-1531
Mailing Address - Fax:
Practice Address - Street 1:126 REVERE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3047
Practice Address - Country:US
Practice Address - Phone:207-332-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-02
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health