=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588523666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOTWELL THERAPY & CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2026
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 CORDAVILLE RD STE 100
-----------------------------------------------------
City | SOUTHBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01772-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-535-6847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 LIBERTY SQ STE 2376
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02109-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-535-6847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | REGINA TETREAULT
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 774-535-6847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------