Basic Information
| Provider Information | |||||||||
| NPI: | 1184795197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROOT | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12TH STREET | ||||||||
| Address2: | PRINCETON COMMUNITY HOSPITAL | ||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 24740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044315073 | ||||||||
| FaxNumber: | 3044877900 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 ST | ||||||||
| Address2: | PRINCETON COMMUNITY HOSPITAL--12TH STREET | ||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 24740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044315073 | ||||||||
| FaxNumber: | 3044877900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | DP00452073 | WV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.