Provider Demographics
NPI:1972962827
Name:WORTHAM, BENJAMIN HEATH (LMSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HEATH
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6252
Mailing Address - Country:US
Mailing Address - Phone:504-390-6441
Mailing Address - Fax:
Practice Address - Street 1:3222 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6252
Practice Address - Country:US
Practice Address - Phone:504-390-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12124104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker