Provider Demographics
NPI:1194530071
Name:ROOTED BEHAVIORAL THERAPY
Entity type:Organization
Organization Name:ROOTED BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAADEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMIMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-942-1339
Mailing Address - Street 1:137 PETERBOROUGH ST APT 27
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4212
Mailing Address - Country:US
Mailing Address - Phone:617-959-2860
Mailing Address - Fax:
Practice Address - Street 1:137 PETERBOROUGH ST APT 27
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4212
Practice Address - Country:US
Practice Address - Phone:617-959-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty