BODEGA ROOTS THERAPY LCSW PLLC
NPI 1811864093
Social Worker - Clinical in Bronx, NY

Active since October 21, 2025
557 GRAND CONCOURSE STE 6017, BRONX, NY 10451(917) 853-9364 Get Directions Write a Review

NPPES record last updated: October 21, 2025. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Bodega Roots Therapy Lcsw Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BODEGA ROOTS THERAPY LCSW PLLC (NPI 1811864093) is a healthcare organization registered as a clinical in Bronx, New York and active in the NPI registry since October 2025. The organization lists Carmen Susana Fajardo, Director, as its authorized official.

NPPES Registry Identity

NPI1811864093
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameBODEGA ROOTS THERAPY LCSW PLLC
Location Address557 GRAND CONCOURSE STE 6017Bronx, NY 10451-5253
Mailing Address557 Grand Concourse Ste 6017Bronx, NY 10451-5253 · (917) 853-9364
Organization SubpartNo
Authorized OfficialCarmen Susana FajardoDirector · (917) 853-9364
Enumeration DateOctober 21, 2025
NPPES CertifiedOctober 21, 2025
NPI 1811864093 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
557 GRAND CONCOURSE STE 6017, Bronx, NY 10451

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bodega Roots Therapy Lcsw PLLC's NPI number?

The NPI number for Bodega Roots Therapy Lcsw PLLC is 1811864093. It was assigned to this organization in the NPPES registry on October 21, 2025.

Where is Bodega Roots Therapy Lcsw PLLC located?

Bodega Roots Therapy Lcsw PLLC is located at 557 Grand Concourse Ste 6017, Bronx, NY 10451. The listed phone number is (917) 853-9364.

What is Bodega Roots Therapy Lcsw PLLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Bodega Roots Therapy Lcsw PLLC was last updated on October 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.