Provider Demographics
NPI:1639525256
Name:ROOTS, BEVERLY WEINSTEIN (LMSW)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:WEINSTEIN
Last Name:ROOTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3012
Mailing Address - Country:US
Mailing Address - Phone:208-771-2779
Mailing Address - Fax:
Practice Address - Street 1:807 N 2ND ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3012
Practice Address - Country:US
Practice Address - Phone:208-771-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-30735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health