Provider Demographics
NPI:1801370333
Name:ROOTS WORK LLC
Entity Type:Organization
Organization Name:ROOTS WORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMATHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:JUVE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-843-1704
Mailing Address - Street 1:313 PRICE PL STE 212
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3262
Mailing Address - Country:US
Mailing Address - Phone:608-886-7686
Mailing Address - Fax:
Practice Address - Street 1:313 PRICE PL STE 212
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3262
Practice Address - Country:US
Practice Address - Phone:608-886-7686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty