Healthcare Provider Details

I. General information

NPI: 1912850504
Provider Name (Legal Business Name): RESTORATIVE ROOTS INTEGRATIVE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 SUMMIT BRIDGE RD
MIDDLETOWN DE
19709-9589
US

IV. Provider business mailing address

3640 CONCORD PIKE # 1025
WILMINGTON DE
19803-5022
US

V. Phone/Fax

Practice location:
  • Phone: 302-303-4555
  • Fax:
Mailing address:
  • Phone: 302-303-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BROWN
Title or Position: FOUNDER
Credential: CRNP, PMHNP
Phone: 302-303-4555