Healthcare Provider Details

I. General information

NPI: 1902734098
Provider Name (Legal Business Name): ROOT THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 TOWNE CENTRE BLVD STE 250
ANNAPOLIS MD
21401-3599
US

IV. Provider business mailing address

1910 TOWNE CENTRE BLVD STE 250
ANNAPOLIS MD
21401-3599
US

V. Phone/Fax

Practice location:
  • Phone: 443-623-8245
  • 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: MR. RYAN ALEX PARKER
Title or Position: THERAPIST
Credential: LCSW-C
Phone: 443-623-8245