Provider Demographics
NPI:1215626627
Name:SEA GLASS FAMILY WELLNESS LLC
Entity type:Organization
Organization Name:SEA GLASS FAMILY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR, FACILITATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, PMHC, CLC, CYT
Authorized Official - Phone:508-840-8942
Mailing Address - Street 1:2 BUXTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-4441
Mailing Address - Country:US
Mailing Address - Phone:508-840-8942
Mailing Address - Fax:
Practice Address - Street 1:2 BUXTON AVE APT 1
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-4441
Practice Address - Country:US
Practice Address - Phone:508-840-8942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty