=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477887255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE BY THE SEA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2009
-----------------------------------------------------
Last Update Date | 09/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 170 WATER ST SUITE 13
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360-3862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-454-0944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 170 WATER STREET SUITE 13
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-454-0944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. PATRICIA MARIE CASINELLI
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 774-454-0944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6793
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------