Provider Demographics
NPI:1528674819
Name:FLOURISHING ROOTS THERAPY LLC
Entity type:Organization
Organization Name:FLOURISHING ROOTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHERTZER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-923-5078
Mailing Address - Street 1:51 WHITE PINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2549
Mailing Address - Country:US
Mailing Address - Phone:203-923-5078
Mailing Address - Fax:
Practice Address - Street 1:51 SHERMAN HILL RD, BUILDING A
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-0679
Practice Address - Country:US
Practice Address - Phone:203-364-4069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008078864Medicaid