1306974183 NPI number — DR. CELINA PINA PSY.D.

Table of content: DR. CELINA PINA PSY.D. (NPI 1306974183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306974183 NPI number — DR. CELINA PINA PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINA
Provider First Name:
CELINA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306974183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 FIELD VIEW LANE
Provider Second Line Business Mailing Address:
PO BOX 0870
Provider Business Mailing Address City Name:
WEST TISBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02575-0870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-996-8800
Provider Business Mailing Address Fax Number:
508-996-8688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02740-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-996-8800
Provider Business Practice Location Address Fax Number:
508-996-8688
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  259 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 160 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 0016381 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 043196299 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000LMG030 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000024854 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1892711 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7543709 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0137530 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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