Healthcare Provider Details

I. General information

NPI: 1366558454
Provider Name (Legal Business Name): KEVIN ALLAN ROOT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 EAST PUTNAM AVE
COS COB CT
06807
US

IV. Provider business mailing address

132 EAST PUTNAM AVE
COS COB CT
06807
US

V. Phone/Fax

Practice location:
  • Phone: 203-622-7406
  • Fax: 203-637-8590
Mailing address:
  • Phone: 203-622-7406
  • Fax: 203-637-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number002600
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002600
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: