Healthcare Provider Details

I. General information

NPI: 1649182361
Provider Name (Legal Business Name): WELL ROOTED PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WHITFIELD ST
GUILFORD CT
06437-3429
US

IV. Provider business mailing address

119 MONTOWESE ST
BRANFORD CT
06405-3807
US

V. Phone/Fax

Practice location:
  • Phone: 203-208-9854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA ANN GREENE
Title or Position: OWNER
Credential: LCSW
Phone: 203-208-9854