Provider Demographics
NPI:1275239931
Name:ROOTED NYC MENTAL HEALTH COUNSELING PLLC
Entity Type:Organization
Organization Name:ROOTED NYC MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:WALLERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:973-617-7628
Mailing Address - Street 1:300 6TH ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7219
Mailing Address - Country:US
Mailing Address - Phone:973-617-7628
Mailing Address - Fax:
Practice Address - Street 1:300 6TH ST APT 1R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7219
Practice Address - Country:US
Practice Address - Phone:973-617-7628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty