NPIMap

Organization Active NPI

Seaside Counseling & Wellness Center, LLC.

  • Clinical Social Worker
  • Berlin, MD
National Provider Identifier
1780935239
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SEASIDE COUNSELING & WELLNESS CENTER, LLC.
Practice address
314 Franklin Ave
Suite 306
Berlin, MD 21811
Phone
(410) 973-2525
Fax
(410) 973-2527
NPI assigned
Sep 24, 2012
Last updated
Nov 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Authorized official

Name
Amy P Ginnavan, LCSW-CNPI 1326179813
Title
Owner
Phone
(410) 973-2525

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

314 Franklin Ave
Suite 306
Berlin, MD 21811

Mailing address

314 Franklin Ave
Suite 306
Berlin, MD 21811
Phone (410) 973-2525

Other practice location 1

1346 S Division St Ste 102
Salisbury, MD 21804-7021
Phone (410) 973-2525

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130412000261 MD Part B Supplier - Clinic/Group Practice 2961648142 Receives reassigned benefits from 8 practitioners
Practice locations: Berlin, MD; Salisbury, MD

National Provider Directory

National Provider Directory
Tax ID family
Seaside Counseling Wellness Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

314 Franklin Ave
Ste 306
Berlin, MD 21811
Phone (410) 973-2525

11809 Ocean Gtwy
Ste 2
Ocean City, MD 21842
Phone (410) 213-7875

1346 S Division St
Ste 102
Salisbury, MD 21804
Phone (410) 749-6822

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1348444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668729600000",
    "number": "1780935239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 FRANKLIN AVE",
            "address_2": "SUITE 306",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "21811",
            "telephone_number": "410-973-2525",
            "fax_number": "410-973-2527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 FRANKLIN AVE",
            "address_2": "SUITE 306",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "21811",
            "telephone_number": "410-973-2525",
            "fax_number": "410-973-2527"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1346 S Division St Ste 102",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218047021",
            "country_code": "US",
            "telephone_number": "410-973-2525",
            "fax_number": "410-973-2527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SEASIDE COUNSELING & WELLNESS CENTER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-24",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A",
        "authorized_official_last_name": "GINNAVAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-973-2525",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; 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.