Shifting Tides Therapy LMSW, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SHIFTING TIDES THERAPY LMSW, PLLC

Practice address

555 Dr MLK Jr St S
Unit 405
Saint Petersburg, FL 33705

Phone

(781) 664-0647

NPI assigned

Jun 26, 2024

Last updated

Jun 26, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deanna Doherty, LCSWNPI 1336780295

Title

Owner

Phone

(781) 664-0647

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deanna Rose Doherty, LMSW

  • Clinical Social Worker
  • New York, NY
  • NPI 1336780295
  NPD Authorized official

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1114762788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "767 BROADWAY",
            "address_2": "#1327",
            "city": "MANHATTAN",
            "state": "NY",
            "postal_code": "10003",
            "telephone_number": "781-664-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 DR MLK JR ST S",
            "address_2": "UNIT 405",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "33705",
            "telephone_number": "781-664-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIFTING TIDES THERAPY LMSW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "DOHERTY",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-664-0647",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MY PERSONAL NPI",
            "identifier": "1336780295",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bailey Shertzinger
• Pamela Diane Sherwin, LCSW
• David Scott Shettle, O.D.
• Logan Scott Shettle, O.D.
• Hester Fay Shieh, MD
• Bonnie Shimel, ISW
• Sean Shipton, P.T.
• Jenna Shively, MSW
• Adriana Lydia Shoaf
• Madison Shockey

• Mental Health Clinic/Center (Including Community Mental Health Center) in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.