Healthcare Provider Details

I. General information

NPI: 1205793908
Provider Name (Legal Business Name): ROOTED THERAPY COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GLEN RD UNIT 3
JAMAICA PLAIN MA
02130-3301
US

IV. Provider business mailing address

20 GLEN RD UNIT 3
JAMAICA PLAIN MA
02130-3301
US

V. Phone/Fax

Practice location:
  • Phone: 207-210-8275
  • Fax:
Mailing address:
  • Phone: 207-210-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE MCGEOUGH
Title or Position: PSYCHOTHERAPIST
Credential: LICSW
Phone: 207-210-8275