Healthcare Provider Details

I. General information

NPI: 1093550642
Provider Name (Legal Business Name): MAKING WAVES MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FOXBOROUGH BLVD STE 230
FOXBOROUGH MA
02035-2878
US

IV. Provider business mailing address

100 FOXBOROUGH BLVD STE 230
FOXBOROUGH MA
02035-2878
US

V. Phone/Fax

Practice location:
  • Phone: 508-426-5883
  • Fax:
Mailing address:
  • Phone: 508-426-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GINA FLORES
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: LICSW
Phone: 908-358-2733