NPIMap

Organization Active NPI

Tidewater Psychotherapy Services

  • Social Worker
  • Virginia Beach, VA
National Provider Identifier
1700830742
Registry record updated Aug 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
2006112732R Issued in VA
Legal business name
TIDEWATER PSYCHOTHERAPY SERVICES
Practice address
260 Grayson Rd
Suite 100
Virginia Beach, VA 23462-4345
Phone
(757) 497-3670
Fax
(757) 499-1947
NPI assigned
May 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2017

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

Authorized official

Name
Louise Friedman, LCSW
Title
President, Authorizaed Offical
Phone
(757) 497-3670

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 204 VA
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X 2006112732R VA Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

260 Grayson Rd
Suite 100
Virginia Beach, VA 23462-4345

Mailing address

260 Grayson Rd
Suite 100
Virginia Beach, VA 23462-4345
Phone (757) 497-3670

Other identifiers 1

IdentifierTypeStateIssuer
1700830742MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040714001441 VA Part B Supplier - Clinic/Group Practice 9335128305 Receives reassigned benefits from 18 practitioners
Practice locations: Virginia Beach, VA

National Provider Directory

National Provider Directory

Locations

256 N Witchduck Rd
Ste G
Virginia Beach, VA 23462
Phone (757) 497-3670

260 Grayson Rd
Virginia Beach, VA 23462
Phone (757) 459-4640

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503273600000",
    "number": "1700830742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 GRAYSON RD",
            "address_2": "SUITE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234624345",
            "telephone_number": "757-497-3670",
            "fax_number": "757-499-1947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 GRAYSON RD",
            "address_2": "SUITE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234624345",
            "telephone_number": "757-497-3670",
            "fax_number": "757-499-1947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER PSYCHOTHERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2017-08-21",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "LOUISE",
        "authorized_official_title_or_position": "PRESIDENT, AUTHORIZAED OFFICAL",
        "authorized_official_telephone_number": "757-497-3670",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "204",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "VA",
            "license": "2006112732R",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700830742",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.