Healthcare Provider Details

I. General information

NPI: 1265290035
Provider Name (Legal Business Name): ROOTED INTEGRATIVE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 YORK RD STE 800-1106
LUTHERVILLE MD
21093-6035
US

IV. Provider business mailing address

1301 YORK RD STE 800-1106
LUTHERVILLE MD
21093-6035
US

V. Phone/Fax

Practice location:
  • Phone: 443-579-5557
  • Fax: 443-327-4747
Mailing address:
  • Phone: 443-579-5557
  • Fax: 443-327-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ROBYN MANNING
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: MS, PHMNP
Phone: 443-331-5230