Organization
DEEP ROOTS WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY BRAVERMAN LAC MAC (OWNER)
(443) 297-9693
Entity
Organization
Contact information
Practice address
733 W. 40TH STREET, PRINT SHOP BUILDING SUITE 20, BALTIMORE, MD 21211
(443) 297-9693
Mailing address
3721 REXMERE RD, BALTIMORE, MD 21218-2011
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/24/2019
Last updated
08/06/2020
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