Life Tide Therapy, LLC
NPI #1114513967 in Charlestown, Massachusetts
Provider Information
- NPI Number
- 1114513967
- Entity Type
- Organization
- Organization Name
- Life Tide Therapy, LLC
- Primary Specialty
- Social Worker - Clinical
- Enumeration Date
- Dec 16, 2020
- Last Updated
- Dec 16, 2020
Practice Location
- Address
- 54 HIGH ST
- City
- Charlestown
- State
- Massachusetts
- ZIP Code
- 02129-3377
- Phone
- (603) 520-6388
Authorized Official
- Name
- DANIELLE A HAYNES, LICSW
- Title
- LICSW
- Phone
- (857) 302-4902
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
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