Provider Demographics
NPI:1043974496
Name:ROBERTA C. ROOD, LICSW
Entity Type:Organization
Organization Name:ROBERTA C. ROOD, LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROOD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-496-4198
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-0172
Mailing Address - Country:US
Mailing Address - Phone:802-496-4198
Mailing Address - Fax:
Practice Address - Street 1:7512 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAITSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05673-6188
Practice Address - Country:US
Practice Address - Phone:802-496-4198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty