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General NPI Number Information
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NPI Number | 1316638299
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Entity Type | Organization
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Legal Business Name | ROOTS AND BRANCHES, PLLC
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 60 PROCTOR AVE
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City | S BURLINGTON
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State | VT
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Zip | 05403-6134
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Country | US
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Telephone | 802-448-2175
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Fax |
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Provider Business Mailing Address
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Address Line | 60 PROCTOR AVE
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City | S BURLINGTON
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State | VT
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Zip | 05403-6134
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Country | US
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Telephone | 802-448-2175
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Fax |
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Authorized Official
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Title or Position | OWNER, PRACTITIONER
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Name | CYNTHIA STANFORD
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Credential | LMFT
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Telephone | 802-448-2175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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