Provider Demographics
NPI:1407402613
Name:ROOT, NAOMI D (LCSW)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:D
Last Name:ROOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 YORK AVE # 20094
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-8819
Mailing Address - Country:US
Mailing Address - Phone:929-265-8595
Mailing Address - Fax:
Practice Address - Street 1:1483 YORK AVE # 20094
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-8819
Practice Address - Country:US
Practice Address - Phone:929-265-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106982104100000X
NY0947101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker