Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bodega Roots Therapy LCSW PLLC

Organization Clinical Social Worker · NPI 1811864093

Bodega Roots Therapy LCSW PLLC is a Clinical Social Worker in Bronx, New York. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

557 Grand Concourse Ste 6017
Bronx, NY 10451-5253
Phone: (917) 853-9364
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1811864093
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Carmen Fajardo — Director · (917) 853-9364
NPI enumeratedOctober 21, 2025
Last updated in NPPESOctober 21, 2025
Certification dateOctober 21, 2025
Mailing address557 Grand Concourse Ste 6017, Bronx, NY 10451-5253

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