Provider Demographics
NPI:1417830027
Name:RESILIENT ROOTS-LICENSED CLINICAL SOCIAL WORK SERVICES, PLLC
Entity type:Organization
Organization Name:RESILIENT ROOTS-LICENSED CLINICAL SOCIAL WORK SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, M-CASAC, MCPC
Authorized Official - Phone:516-404-9884
Mailing Address - Street 1:PO BOX 7143
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-0743
Mailing Address - Country:US
Mailing Address - Phone:516-404-9884
Mailing Address - Fax:
Practice Address - Street 1:27 DEEP LN
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1805
Practice Address - Country:US
Practice Address - Phone:516-404-9884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty