Healthcare Provider Details

I. General information

NPI: 1992450142
Provider Name (Legal Business Name): ROOT SALVE, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24825 NORTHERN BLVD
LITTLE NECK NY
11362-1211
US

IV. Provider business mailing address

248-25 NORTHERN BLVD SUITE 1-J PMB 2022
LITTLE NECK NY
11362
US

V. Phone/Fax

Practice location:
  • Phone: 347-766-8788
  • Fax:
Mailing address:
  • Phone: 347-766-8788
  • 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: DR. JALANA HARRIS
Title or Position: OWNER
Credential: PHD, LCSW-R
Phone: 347-551-7384