Provider Demographics
NPI:1497500888
Name:ROOT & BLOOM THERAPY LLC
Entity type:Organization
Organization Name:ROOT & BLOOM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESTNUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-375-0374
Mailing Address - Street 1:176 N BEAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHAPLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06235-2421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1153 MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-3115
Practice Address - Country:US
Practice Address - Phone:860-375-0374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty