Organization
SHIFTING TIDES THERAPY LMSW, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA DOHERTY LCSW (OWNER)
(781) 664-0647
Entity
Organization
Contact information
Practice address
555 DR MLK JR ST S, UNIT 405, SAINT PETERSBURG, FL 33705
(781) 664-0647
Mailing address
767 BROADWAY, #1327, MANHATTAN, NY 10003
(781) 664-0647
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336780295
MY PERSONAL NPI
NY
Enumeration date
06/26/2024
Last updated
06/26/2024
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