Provider Demographics
NPI:1184893042
Name:WORTHAM, OFFIE (PHD)
Entity type:Individual
Prefix:DR
First Name:OFFIE
Middle Name:
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4170
Mailing Address - Country:US
Mailing Address - Phone:802-454-1419
Mailing Address - Fax:802-454-1419
Practice Address - Street 1:136 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4170
Practice Address - Country:US
Practice Address - Phone:802-454-1419
Practice Address - Fax:802-454-1419
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0970001181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health