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General NPI Number Information
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NPI Number | 1184386047
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Entity Type | Organization
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Legal Business Name | SPROUTING ROOTS MHC P.C.
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 477 MADISON AVE FL 6
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City | NEW YORK
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State | NY
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Zip | 10022-5827
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Country | US
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Telephone | 845-444-2973
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Fax |
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Provider Business Mailing Address
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Address Line | 477 MADISON AVE FL 6
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City | NEW YORK
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State | NY
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Zip | 10022-5827
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Country | US
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Telephone | 845-444-2973
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Fax | 866-441-0955
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Authorized Official
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Title or Position | OWNER
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Name | SADIE MILLER-DALEY
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Credential | LMHC
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Telephone | 845-444-2973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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