| Life Tide Therapy, Llc | |
|
54 High St Charlestown MA 02129-3377 | |
| (603) 520-6388 | |
| Not Available |
| Full Name | Life Tide Therapy, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 54 High St, Charlestown, Massachusetts |
| Authorized Official Name and Position | Danielle A Haynes (LICSW) |
| Authorized Official Contact | 8573024902 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Tide Therapy, Llc 54 High St Charlestown MA 02129-3377 Ph: (603) 520-6388 | Life Tide Therapy, Llc 54 High St Charlestown MA 02129-3377 Ph: (603) 520-6388 |
| NPI Number | 1114513967 |
|---|---|
| Provider Enumeration Date | 12/16/2020 |
| Last Update Date | 12/16/2020 |
| Certification Date | 12/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114513967 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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