Life Tide Therapy, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LIFE TIDE THERAPY, LLC

Practice address

54 High St
Charlestown, MA 02129-3377

Phone

(603) 520-6388

NPI assigned

Dec 16, 2020

Organization subpart

No

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

Authorized official

Name

Danielle A Haynes, LICSWNPI 1639487986

Title

Licsw

Phone

(857) 302-4902

Specialties & licenses 1

Addresses

Other names 1

• Danielle A Haynes Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Danielle A Haynes

  • Clinical Social Worker
  • Somerville, MA
  • NPI 1639487986
  NPD Authorized official

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

{
    "created_epoch": "1608076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1114513967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 HIGH ST",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021293377",
            "telephone_number": "603-520-6388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 HIGH ST",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021293377",
            "telephone_number": "603-520-6388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13 Bowdoin St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021144246",
            "country_code": "US",
            "telephone_number": "857-302-4902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE TIDE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-16",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "LICSW",
        "authorized_official_telephone_number": "857-302-4902",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Danielle A Haynes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julie Maney Lewis, PSYD
• Lorenzo Lewis Jr., MD
• Sandra Veronica Leyan Castillo
• Wei Sum Li, M.D.
• Life Focus Center of Charlestown, Inc
• Joyce Fu Liu, MD
• Molly Virginia Longwell
• Sandra Joana Louis-Charles, RN
• Love and Light Psychiatry PLLC
• Siew Kwaon Lui, M.D.

• Clinical Social Worker in Charlestown, MA
• Providers in Charlestown, 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 16, 2020; 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.