Provider Demographics
NPI:1316638299
Name:ROOTS AND BRANCHES, PLLC
Entity type:Organization
Organization Name:ROOTS AND BRANCHES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:802-448-2175
Mailing Address - Street 1:60 PROCTOR AVE
Mailing Address - Street 2:
Mailing Address - City:S BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6134
Mailing Address - Country:US
Mailing Address - Phone:802-448-2175
Mailing Address - Fax:
Practice Address - Street 1:60 PROCTOR AVE
Practice Address - Street 2:
Practice Address - City:S BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6134
Practice Address - Country:US
Practice Address - Phone:802-448-2175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty