Provider Demographics
NPI:1174842710
Name:PINE, MARGARET A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:PINE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:PINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW,LCSW
Mailing Address - Street 1:220 E SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-4624
Mailing Address - Country:US
Mailing Address - Phone:970-209-5142
Mailing Address - Fax:
Practice Address - Street 1:220 E SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-4624
Practice Address - Country:US
Practice Address - Phone:970-209-5142
Practice Address - Fax:307-742-6572
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 171M00000X
CO099309041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator