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General NPI Number Information
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NPI Number | 1477142727
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Entity Type | Organization
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Legal Business Name | ENROOT MENTAL HEALTH & WELLNESS
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 617 E PALISADE AVE STE 101
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-1831
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Country | US
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Telephone | 201-919-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 LINDEN AVE
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-1007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CATHERINE KIM
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Credential | PMHNP-BC
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Telephone | 201-919-5351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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