Deep Tides Therapy PLLC

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

DEEP TIDES THERAPY PLLC

Practice address

1804 E 18TH St
Georgetown, TX 78626-7322

Phone

(503) 754-2817

NPI assigned

Feb 24, 2025

Last updated

Feb 24, 2025By 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

Corina WolfensteinNPI 1730858770

Title

Owner of Entity

Phone

(503) 754-2817

Specialties & licenses 1

Addresses

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.

• Corina Penelope Wolfenstein, LMSW

  • Social Worker
  • San Antonio, TX
  • NPI 1730858770
  NPD Authorized official

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

{
    "created_epoch": "1740355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1649076191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14205 N MO PAC EXPY STE 570",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787286529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 E 18TH ST",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786267322",
            "telephone_number": "503-754-2817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEP TIDES THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-24",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "WOLFENSTEIN",
        "authorized_official_first_name": "CORINA",
        "authorized_official_title_or_position": "OWNER OF ENTITY",
        "authorized_official_telephone_number": "503-754-2817"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ursula Denice Davis
• Sangeetha Dayalan, M.D.
• Nayeli De Hoyos, MS, LPC-ASSOCIATE
• Bethany Dean, SLP
• Deborah L Bland LCSW PLLC
• Laura Elaine Defreitas, APRN, FNP-C
• Dominic R. Dekeratry, M.D.
• Ghenica-Rose Yap Delfin, PHARMD
• John E Delhagen, M.D.
• Stephanie Deloera

• Social Worker in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; 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.