MEDICARE: HAVENROOT THERAPY AND WELLNESS

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1902766520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVENROOT THERAPY AND WELLNESS

Provider Business Mailing Address
First Line	:	5535 BELLEVILLE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-6945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 BELLEVILLE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-6945
Country	:	US
Telephone Number	:	443-502-0825
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	IKECHUKWU NWAKANMA
Credential	:
Telephone Number	:	443-502-0825

Provider Enumeration Date	:	11/15/2025
Last Update Date	:	12/15/2025

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Directions to “HAVENROOT THERAPY AND WELLNESS ” Practice Location

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