Provider Demographics
NPI:1982982906
Name:PINA, RICARDO (MA)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:PINA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8113
Mailing Address - Country:US
Mailing Address - Phone:954-462-4489
Mailing Address - Fax:954-462-4490
Practice Address - Street 1:547 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-8113
Practice Address - Country:US
Practice Address - Phone:954-462-4489
Practice Address - Fax:954-462-4490
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health