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General NPI Number Information
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NPI Number | 1487276176
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Entity Type | Individual
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Provider Name | MICHELE ROOT LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 2108 N ST # 9254
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone | 408-320-5377
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 390852
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94039-0852
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Country | US
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Telephone | 408-320-5377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 121718
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License Number State | CA
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