Provider Demographics
NPI:1427911411
Name:ROOTS & WINGS THERAPY SERVICES INCORPORATED
Entity type:Organization
Organization Name:ROOTS & WINGS THERAPY SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-377-2719
Mailing Address - Street 1:67 BUCK TAIL LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8445
Mailing Address - Country:US
Mailing Address - Phone:609-377-2719
Mailing Address - Fax:609-377-2719
Practice Address - Street 1:67 BUCK TAIL LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-8445
Practice Address - Country:US
Practice Address - Phone:609-377-2719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-05
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)