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General NPI Number Information
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NPI Number | 1861296055
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Entity Type | Organization
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Legal Business Name | ROOT & REACH PROFESSIONAL LTD LIABILITY CO
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 44 GREENWAY ST
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City | HAMDEN
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State | CT
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Zip | 06517-1318
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Country | US
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Telephone | 440-223-7123
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Fax |
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Provider Business Mailing Address
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Address Line | 44 GREENWAY ST
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City | HAMDEN
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State | CT
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Zip | 06517-1318
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Country | US
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Telephone | 440-223-7123
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KATELYN MORIAH SMITH-BRESKY
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Credential | PSYD
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Telephone | 440-223-7123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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