Healthcare Provider Details

I. General information

NPI: 1013847763
Provider Name (Legal Business Name): DEEPLY ROOTED THERAPEUTIC SERVICES LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 AVENUE U # 1085
BROOKLYN NY
11229-5062
US

IV. Provider business mailing address

2602 AVENUE U # 1085
BROOKLYN NY
11229-5062
US

V. Phone/Fax

Practice location:
  • Phone: 917-935-0761
  • Fax:
Mailing address:
  • Phone: 917-935-0761
  • 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: KAMILAH MATTHEW
Title or Position: OWNER
Credential: LCSW
Phone: 917-935-0761