Healthcare Provider Details

I. General information

NPI: 1164613154
Provider Name (Legal Business Name): GINA BREGGIA-PINE, LICSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHMOND SQ STE 130C
PROVIDENCE RI
02906-5155
US

IV. Provider business mailing address

PO BOX 165
BARRINGTON RI
02806-0165
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-2270
  • Fax: 401-944-0026
Mailing address:
  • Phone: 401-944-2270
  • Fax: 401-944-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. GINA M PINE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LICSW
Phone: 401-944-2270