Healthcare Provider Details

I. General information

NPI: 1083220099
Provider Name (Legal Business Name): SAMANTHA PINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MONTEBELLO RD STE 116
PUEBLO CO
81001-1366
US

IV. Provider business mailing address

41 MONTEBELLO RD STE 204
PUEBLO CO
81001-1379
US

V. Phone/Fax

Practice location:
  • Phone: 719-423-1500
  • Fax: 719-542-9269
Mailing address:
  • Phone: 719-545-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933790
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002662
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: