Active NPI
Mindful Roots Psychotherapy, LLC
- Clinical Psychologist
- Charlton, MA
National Provider Identifier
1306758305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Legal business name
- MINDFUL ROOTS PSYCHOTHERAPY, LLC
- Practice address
- 131 Burlingame Rd
Charlton, MA 01507-5204 - Phone
- (508) 581-3965
- NPI assigned
- Sep 22, 2026
- Last updated
- Sep 22, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ryan Davidson, PHD
- Title
- Owner
- Phone
- (508) 581-3956
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | NU | Primary |
Addresses
Primary practice location
131 Burlingame Rd
Charlton, MA 01507-5204
Mailing address
120 Charlton Rd Ste 2
Sturbridge, MA 01566-1564
Phone (508) 581-3965
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790035200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790035200000",
"number": "1306758305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 CHARLTON RD STE 2",
"city": "STURBRIDGE",
"state": "MA",
"postal_code": "015661564",
"telephone_number": "508-581-3965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 BURLINGAME RD",
"city": "CHARLTON",
"state": "MA",
"postal_code": "015075204",
"telephone_number": "508-581-3965"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MINDFUL ROOTS PSYCHOTHERAPY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-22",
"last_updated": "2026-09-22",
"certification_date": "2026-09-22",
"status": "A",
"authorized_official_last_name": "DAVIDSON",
"authorized_official_first_name": "RYAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "508-581-3956",
"authorized_official_credential": "PHD"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.