MEDICARE: ROOTED INTEGRATIVE PSYCHIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1265290035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED INTEGRATIVE PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	1301 YORK RD STE 800-1106
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6035
Country	:	US
Telephone Number	:	443-579-5557
Fax Number	:	443-327-4747

Provider Business Practice Location Address
First Line	:	1301 YORK RD STE 800-1106
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6035
Country	:	US
Telephone Number	:	443-579-5557
Fax Number	:	443-327-4747

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	MRS. ROBYN MANNING
Credential	:	MS, PHMNP
Telephone Number	:	443-331-5230

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	05/27/2026

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