Provider Demographics
NPI:1457159287
Name:ROOTS MIDWIFERY LLC
Entity type:Organization
Organization Name:ROOTS MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROFESSIONAL MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DAWN-MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:617-833-9396
Mailing Address - Street 1:7 HARVARD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7979
Mailing Address - Country:US
Mailing Address - Phone:617-413-8300
Mailing Address - Fax:857-347-5499
Practice Address - Street 1:7 HARVARD ST STE 204
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7979
Practice Address - Country:US
Practice Address - Phone:617-413-8300
Practice Address - Fax:857-347-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty