Provider Demographics
NPI:1790580264
Name:ROOTS TO ROSES PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:ROOTS TO ROSES PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:KUDLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-529-0355
Mailing Address - Street 1:45 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-3604
Mailing Address - Country:US
Mailing Address - Phone:908-529-0355
Mailing Address - Fax:
Practice Address - Street 1:45 PERRY ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-3604
Practice Address - Country:US
Practice Address - Phone:908-529-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty