| Blue Wave Counseling & Psychotherapy Llc | |
|
1519 Market St Pocomoke City MD 21851-1711 | |
| (484) 767-5216 | |
| Not Available |
| Full Name | Blue Wave Counseling & Psychotherapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1519 Market St, Pocomoke City, Maryland |
| Authorized Official Name and Position | Sean Butler (OWNER) |
| Authorized Official Contact | 4847675216 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Wave Counseling & Psychotherapy Llc 1519 Market St Pocomoke City MD 21851-1711 Ph: (484) 767-5216 | Blue Wave Counseling & Psychotherapy Llc 1519 Market St Pocomoke City MD 21851-1711 Ph: (484) 767-5216 |
| NPI Number | 1891391587 |
|---|---|
| Provider Enumeration Date | 12/08/2020 |
| Last Update Date | 02/03/2021 |
| Certification Date | 02/03/2021 |
| Medicare PECOS PAC ID | 4385058890 |
|---|---|
| Medicare Enrollment ID | O20210125001181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891391587 | NPI | - | NPPES |
| 666873900 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sean Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770039273 PECOS PAC ID: 5597193128 Enrollment ID: I20200313002057 |
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