Provider Demographics
NPI:1982782280
Name:HINE, PETER PAUL
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:PAUL
Last Name:HINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:P
Other - Last Name:HINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:7512 GOODHUE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4634
Mailing Address - Country:US
Mailing Address - Phone:303-432-5958
Mailing Address - Fax:
Practice Address - Street 1:7512 GOODHUE BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4634
Practice Address - Country:US
Practice Address - Phone:303-432-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9850221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical