Provider Demographics
NPI:1225049471
Name:WENTWORTH, JUDITH E (MSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10812 CLERMONT AVE.
Mailing Address - Street 2:#459
Mailing Address - City:GARRETT PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20896-0459
Mailing Address - Country:US
Mailing Address - Phone:301-946-0843
Mailing Address - Fax:301-946-6953
Practice Address - Street 1:4545 CONNECTICUT AVE NW
Practice Address - Street 2:#417
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-6042
Practice Address - Country:US
Practice Address - Phone:202-244-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3020131041C0700X
MD059501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMU033688Medicare ID - Type Unspecified