Provider Demographics
NPI:1013997287
Name:WERTHEIM, WILLIAM J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:WERTHEIM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1216
Mailing Address - Country:US
Mailing Address - Phone:914-664-5681
Mailing Address - Fax:914-664-6591
Practice Address - Street 1:100 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1216
Practice Address - Country:US
Practice Address - Phone:914-664-5681
Practice Address - Fax:914-664-6591
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR018792-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN46821Medicare ID - Type Unspecified