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General NPI Number Information
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NPI Number | 1952284317
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Entity Type | Organization
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Legal Business Name | DEEPLY ROOTED LLC
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 9 BERKELEY ST
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City | NORWALK
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State | CT
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Zip | 06850-3987
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Country | US
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Telephone | 203-408-2257
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Fax |
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Provider Business Mailing Address
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Address Line | 390 CHARLES ST APT 105
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5676
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Country | US
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Telephone | 914-619-0522
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MARKYSHA DOUGLAS
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Credential | LCSW
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Telephone | 203-408-2257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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