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General NPI Number Information
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NPI Number | 1235840612
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Entity Type | Organization
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Legal Business Name | ROOTS & RIPTIDES PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 12/07/2022
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 4 MARKET PLACE DR STE 201D
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City | YORK
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State | ME
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Zip | 03909-1552
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Country | US
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Telephone | 207-994-9453
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Fax | 207-221-1711
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Provider Business Mailing Address
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Address Line | PO BOX 182
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City | YORK HARBOR
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State | ME
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Zip | 03911-0182
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Country | US
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Telephone | 207-248-1818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA J BOYLE
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Credential | LCSW
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Telephone | 207-248-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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