Provider Demographics
NPI:1285909911
Name:ROOT, VICKI (LCSW)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27460 HITCHING POST CT
Mailing Address - Street 2:
Mailing Address - City:HARBESON
Mailing Address - State:DE
Mailing Address - Zip Code:19951-2700
Mailing Address - Country:US
Mailing Address - Phone:302-381-8598
Mailing Address - Fax:
Practice Address - Street 1:17527 NASSAU COMMONS BLVD # 101
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6283
Practice Address - Country:US
Practice Address - Phone:302-381-8598
Practice Address - Fax:302-381-8598
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100009981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical