| Seaside Counseling & Wellness Center, Llc. | |
|
314 Franklin Ave Suite 306 Berlin MD 21811 | |
| (410) 973-2525 | |
| (410) 973-2527 |
| Full Name | Seaside Counseling & Wellness Center, Llc. |
|---|---|
| Speciality | Social Worker |
| Location | 314 Franklin Ave, Berlin, Maryland |
| Authorized Official Name and Position | Amy P Ginnavan (OWNER) |
| Authorized Official Contact | 4109732525 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Seaside Counseling & Wellness Center, Llc. 314 Franklin Ave Suite 306 Berlin MD 21811 Ph: (410) 973-2525 | Seaside Counseling & Wellness Center, Llc. 314 Franklin Ave Suite 306 Berlin MD 21811 Ph: (410) 973-2525 |
| NPI Number | 1780935239 |
|---|---|
| Provider Enumeration Date | 09/24/2012 |
| Last Update Date | 11/18/2022 |
| Certification Date | 11/18/2022 |
| Medicare PECOS PAC ID | 2961648142 |
|---|---|
| Medicare Enrollment ID | O20130412000261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780935239 | NPI | - | NPPES |
| Provider Name | Katherine Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215151964 PECOS PAC ID: 4688750334 Enrollment ID: I20080321000109 |
| Provider Name | Debra Ann Dotson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306975446 PECOS PAC ID: 3173694106 Enrollment ID: I20080619000346 |
| Provider Name | Mary Kaul-black |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215006598 PECOS PAC ID: 6305038282 Enrollment ID: I20101011000541 |
| Provider Name | Valerie Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639323108 PECOS PAC ID: 5294916185 Enrollment ID: I20110225000121 |
| Provider Name | Erin K Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215294699 PECOS PAC ID: 6406005461 Enrollment ID: I20121008000072 |
| Provider Name | Amy P Ginnavan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326179813 PECOS PAC ID: 9234375429 Enrollment ID: I20130412000387 |
| Provider Name | Jared T Rowan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336442177 PECOS PAC ID: 8426296658 Enrollment ID: I20130530000236 |
| Provider Name | Jessica M Hagy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285905208 PECOS PAC ID: 6901032622 Enrollment ID: I20131202000051 |
| Provider Name | Cameron R Cluster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467866525 PECOS PAC ID: 3870861016 Enrollment ID: I20170613000506 |
| Provider Name | Nina S Pusey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447502802 PECOS PAC ID: 6002178381 Enrollment ID: I20180326002818 |
| Provider Name | Kimberly A Fogle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427533066 PECOS PAC ID: 9335571454 Enrollment ID: I20191112000381 |
| Provider Name | Bibiana Koh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730191040 PECOS PAC ID: 9133147002 Enrollment ID: I20231128003131 |
| Provider Name | Robert Wayne Realini |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073165536 PECOS PAC ID: 9931542354 Enrollment ID: I20240213000978 |
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