Seaside Counseling, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

111091 Issued in MA

Legal business name

SEASIDE COUNSELING, LLC

Practice address

85 Eastern Ave
Suite G102
Gloucester, MA 01930-6512

Phone

(978) 852-8042

NPI assigned

Dec 4, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Courtney H Wilson, LICSW

Title

Co Owner

Phone

(978) 852-8042

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259884800000",
    "number": "1073841995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 EASTERN AVE",
            "address_2": "SUITE G102",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019306512",
            "telephone_number": "978-852-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 EASTERN AVE",
            "address_2": "SUITE G102",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019306512",
            "telephone_number": "978-852-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASIDE COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-04",
        "last_updated": "2009-12-04",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "978-852-8042",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "MA",
            "license": "215746",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Andrea Shaw

• Clinical Social Worker in Gloucester, MA
• Providers in Gloucester, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.