Provider Demographics
NPI:1235840612
Name:ROOTS & RIPTIDES PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:ROOTS & RIPTIDES PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-248-1818
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:YORK HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:03911-0182
Mailing Address - Country:US
Mailing Address - Phone:207-248-1818
Mailing Address - Fax:
Practice Address - Street 1:4 MARKET PLACE DR STE 201D
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1552
Practice Address - Country:US
Practice Address - Phone:207-994-9453
Practice Address - Fax:207-221-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty