Healthcare Provider Details

I. General information

NPI: 1063323764
Provider Name (Legal Business Name): SALTWATER WELLNESS LLC BY DAWN KETER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 THOMAS CT
BERLIN MD
21811-1183
US

IV. Provider business mailing address

102 THOMAS CT
BERLIN MD
21811-1183
US

V. Phone/Fax

Practice location:
  • Phone: 443-781-6307
  • Fax:
Mailing address:
  • Phone: 443-781-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAWN KETER
Title or Position: CLINICAL SOCIAL WORKER/THERAPIST
Credential:
Phone: 443-781-6307