MEDICARE: ROOTED THERAPY COLLECTIVE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1205793908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED THERAPY COLLECTIVE, LLC

Provider Business Mailing Address
First Line	:	20 GLEN RD UNIT 3
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3301
Country	:	US
Telephone Number	:	207-210-8275
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 GLEN RD UNIT 3
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3301
Country	:	US
Telephone Number	:	207-210-8275
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	CATHERINE MCGEOUGH
Credential	:	LICSW
Telephone Number	:	207-210-8275

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ROOTED THERAPY COLLECTIVE, LLC ” Practice Location

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