Doctor Name: | KERSEINYA GRETCHEN WENTWORTH |
NPI Number: | 1043441413 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSWR |
License Number: | 041878 |
Business Practice Address: | 106 S Perry St Ste 4 Watkins Glen, NY - 148911615 |
Business Phone Number: | 6075358282 |
Business Fax Number: | 6075358284 |
Mailing Address: | 106 S Perry St, Ste 4 WATKINS GLEN |
State: | NY |
Postal Code: | 148911615 |
Phone Number: | 6075358282 |
Fax Number: | 6075358284 |
NPI Enumeration Date: | 08/04/2009 |
NPI Last Update Date: | 08/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 041878 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |