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NPI Code Detail

MEDICARE: THE COLLABORATIVE GOOD, LLC

MEDICARE: THE COLLABORATIVE GOOD, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0903002363VA

General Provider Information

NPI Number : 1033668603
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE COLLABORATIVE GOOD, LLC
Provider Business Mailing Address
First Line : 2308 MOUNT VERNON AVE
Second Line : #123
City : ALEXANDRIA
State : VA
Zip : 22301-1328
Country : US
Telephone Number : 718-974-7037
Fax Number :
Provider Business Practice Location Address
First Line : 133 PARK ST NE
Second Line : #3B
City : VIENNA
State : VA
Zip : 22180-4666
Country : US
Telephone Number : 718-974-7037
Fax Number :
Authorized Official
Title or Position : LMSW/OWNER
Name : MARIA PILAR PINA
Credential : LMSW
Telephone Number : 718-974-7037
Provider Enumeration Date : 09/23/2016
Last Update Date : 09/23/2016

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Directions to “THE COLLABORATIVE GOOD, LLC ” Practice Location

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