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General NPI Number Information
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NPI Number | 1457159287
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Entity Type | Organization
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Legal Business Name | ROOTS MIDWIFERY LLC
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 7 HARVARD ST STE 204
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City | BROOKLINE
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State | MA
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Zip | 02445-7979
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Country | US
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Telephone | 617-413-8300
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Fax | 857-347-5499
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Provider Business Mailing Address
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Address Line | 7 HARVARD ST STE 204
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City | BROOKLINE
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State | MA
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Zip | 02445-7979
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Country | US
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Telephone | 617-413-8300
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Fax | 857-347-5499
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Authorized Official
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Title or Position | CERTIFIED PROFESSIONAL MIDWIFE
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Name | STEPHANIE DAWN-MARIE JOHNSON
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Credential | CPM
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Telephone | 617-833-9396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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