=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689468845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTY ROOTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2025
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 WATER STREET
-----------------------------------------------------
City | DAMARISCOTTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-682-0133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7
-----------------------------------------------------
City | DAMARISCOTTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04543-0007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-682-0133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE MANAGER
-----------------------------------------------------
Name | CAROL MORRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-682-0133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------