Provider Demographics
NPI:1144915414
Name:ROOT AND BRANCH PARENTHOOD
Entity type:Organization
Organization Name:ROOT AND BRANCH PARENTHOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDWATER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:301-219-8195
Mailing Address - Street 1:4054 N LINCOLN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3144
Mailing Address - Country:US
Mailing Address - Phone:123-569-0437
Mailing Address - Fax:
Practice Address - Street 1:4054 N LINCOLN AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3144
Practice Address - Country:US
Practice Address - Phone:123-569-0437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)