Healthcare Provider Details

I. General information

NPI: 1295630259
Provider Name (Legal Business Name): BIRCH ROOT PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HIGH ST
PLAINFIELD VT
05667-4401
US

IV. Provider business mailing address

PO BOX 43
PLAINFIELD VT
05667-0043
US

V. Phone/Fax

Practice location:
  • Phone: 802-456-0557
  • Fax:
Mailing address:
  • Phone: 802-456-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DIANA BROOKS
Title or Position: OWNER
Credential: LCSW, MS
Phone: 802-456-0557