Provider Demographics
NPI:1689816464
Name:WENTWORTH, BRENDA (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WENTWORTH
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 1:243 MOOAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:ME
Mailing Address - Zip Code:04352-3231
Mailing Address - Country:US
Mailing Address - Phone:207-557-1870
Mailing Address - Fax:
Practice Address - Street 1:6 STODDARD LN
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1429
Practice Address - Country:US
Practice Address - Phone:207-557-1870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11851041C0700X
MELC35311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical