Provider Demographics
NPI:1578344685
Name:ROOTS FAMILY CONSULTING, LLC
Entity Type:Organization
Organization Name:ROOTS FAMILY CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:862-703-6452
Mailing Address - Street 1:20 STEVEN TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2914
Mailing Address - Country:US
Mailing Address - Phone:862-703-6452
Mailing Address - Fax:
Practice Address - Street 1:20 STEVEN TER
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2914
Practice Address - Country:US
Practice Address - Phone:862-703-6452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1679829279OtherLISA ZAHARIOUDAKIS, BCBA 1-12-10271