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General NPI Number Information
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NPI Number | 1184575813
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Entity Type | Organization
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Legal Business Name | ROOT AND RENEW THERAPY LCSW PLLC
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 585 STEWART AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-4783
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Country | US
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Telephone | 917-810-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 85 SOUNDVIEW RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-4106
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Country | US
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Telephone | 917-789-2497
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Fax |
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Authorized Official
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Title or Position | LCSW, OWNER
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Name | ALEXANDRA MEZEUL
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Credential | LCSW
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Telephone | 917-789-2497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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