Provider Demographics
NPI:1508752387
Name:PEACEFULLY ROOTED PSYCHIATRIC SERVICES L.L.C.
Entity type:Organization
Organization Name:PEACEFULLY ROOTED PSYCHIATRIC SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MAGNOLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIP-ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, APN, AGNP-C
Authorized Official - Phone:908-265-2114
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-0030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 NEW RD STE 304
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-5625
Practice Address - Country:US
Practice Address - Phone:908-265-2114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty