Healthcare Provider Details

I. General information

NPI: 1972832798
Provider Name (Legal Business Name): PAIGE R PINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 ROCKFORD CT
KOKOMO IN
46902-3207
US

IV. Provider business mailing address

1531 ROCKFORD CT PO BOX 6459
KOKOMO IN
46902-3207
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-4500
  • Fax: 765-453-4525
Mailing address:
  • Phone: 765-453-4500
  • Fax: 765-453-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: