Healthcare Provider Details

I. General information

NPI: 1104752450
Provider Name (Legal Business Name): ROOT AND RIVER COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 S MAIN ST
WATERBURY VT
05676-1547
US

IV. Provider business mailing address

93 S MAIN ST
WATERBURY VT
05676-1547
US

V. Phone/Fax

Practice location:
  • Phone: 774-364-2731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATE MCCARTHY
Title or Position: CO-OWNER
Credential: LICSW
Phone: 774-364-2731