Provider Demographics
NPI:1962937391
Name:PINTADO, MICHELLE (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PINTADO
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CREEKSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3744
Mailing Address - Country:US
Mailing Address - Phone:770-376-0906
Mailing Address - Fax:
Practice Address - Street 1:220 HERITAGE WALK STE 101
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6458
Practice Address - Country:US
Practice Address - Phone:770-376-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21428101YA0400X
NY098700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1962937391OtherMAGNACARE
NY1962937391OtherHIP
NY1962937391Medicaid
NY1962937391OtherOXFORD
NY1962937391OtherAETNA
NY1962937391Other1199
NY1962937391OtherCDPHP
NY1962937391OtherUNITED HEALTHCARE
NY1962937391OtherANTHEM COMPANY
NY1962937391OtherEMBLEM HEALTH
NY1962937391OtherCIGNA
NY1962937391OtherCDPHP
NY1962937391OtherAETNA
NY1962937391Medicare NSC
NY1962937391OtherMAGNACARE