Provider Demographics
NPI:1992450142
Name:ROOT SALVE, LCSW, PLLC
Entity type:Organization
Organization Name:ROOT SALVE, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-R
Authorized Official - Phone:347-551-7384
Mailing Address - Street 1:248-25 NORTHERN BLVD
Mailing Address - Street 2:SUITE 1-J PMB 2022
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362
Mailing Address - Country:US
Mailing Address - Phone:347-766-8788
Mailing Address - Fax:
Practice Address - Street 1:397 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5292
Practice Address - Country:US
Practice Address - Phone:347-766-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty