MEDICARE: SEA GLASS CLINICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1053250050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA GLASS CLINICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 53003
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02153-0003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 FLORENCE ST
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02155-4508
Country	:	US
Telephone Number	:	617-209-9890
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALYSSA CHROBUCK
Credential	:	LICSW
Telephone Number	:	206-612-0430

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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Directions to “SEA GLASS CLINICAL SERVICES LLC ” Practice Location

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