Healthcare Provider Details

I. General information

NPI: 1306775143
Provider Name (Legal Business Name): RADICALLY ROOTED CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 SCOTT DR
MANCHESTER CT
06042-2359
US

IV. Provider business mailing address

76 SCOTT DR
MANCHESTER CT
06042-2359
US

V. Phone/Fax

Practice location:
  • Phone: 808-313-0179
  • Fax:
Mailing address:
  • Phone: 808-313-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: PAIGE ALANA CHEN
Title or Position: FOUNDER, LICENSED BEHAVIOR ANALYST
Credential: BCBA, LBA
Phone: 808-313-0179