| Radical Roots Psychotherapy, A Licensed Clinical Social Worker, Pc | |
|
1875 Mac Duee Ct. San Jose CA 95121 | |
| (609) 694-1872 | |
| Not Available |
| Full Name | Radical Roots Psychotherapy, A Licensed Clinical Social Worker, Pc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1875 Mac Duee Ct., San Jose, California |
| Authorized Official Name and Position | Alexis Mathias (CEO/OWNER) |
| Authorized Official Contact | 6096941872 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Radical Roots Psychotherapy, A Licensed Clinical Social Worker, Pc 440 N Barranca Ave # 1918 Covina CA 91723-1722 Ph: (609) 694-1872 | Radical Roots Psychotherapy, A Licensed Clinical Social Worker, Pc 1875 Mac Duee Ct. San Jose CA 95121 Ph: (609) 694-1872 |
| NPI Number | 1003664947 |
|---|---|
| Provider Enumeration Date | 05/07/2024 |
| Last Update Date | 05/07/2024 |
| Certification Date | 05/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003664947 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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