Provider Demographics
NPI:1710602149
Name:SERENITY SEAS THERAPY, LLC
Entity Type:Organization
Organization Name:SERENITY SEAS THERAPY, LLC
Other - Org Name:SERENITY SEAS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROCATO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-216-4297
Mailing Address - Street 1:716 GIDDINGS AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1419
Mailing Address - Country:US
Mailing Address - Phone:410-216-4297
Mailing Address - Fax:
Practice Address - Street 1:716 GIDDINGS AVE STE 33
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1419
Practice Address - Country:US
Practice Address - Phone:443-910-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty