Healthcare Provider Details

I. General information

NPI: 1063204428
Provider Name (Legal Business Name): TIDAL TRANQUILITY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEBSTER ST STE 5
HANOVER MA
02339-1227
US

IV. Provider business mailing address

16926 89TH PL N
LOXAHATCHEE FL
33470-2777
US

V. Phone/Fax

Practice location:
  • Phone: 508-536-8469
  • Fax:
Mailing address:
  • Phone: 508-536-8469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN YECKER
Title or Position: OWNER
Credential: LICSW, LCSW
Phone: 508-536-8469