Provider Demographics
NPI:1700809225
Name:WORTH, SHERRY L (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:L
Last Name:WORTH
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:635 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3602
Mailing Address - Country:US
Mailing Address - Phone:316-660-7675
Mailing Address - Fax:316-832-1571
Practice Address - Street 1:1919 N AMIDON AVE
Practice Address - Street 2:STE. 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2117
Practice Address - Country:US
Practice Address - Phone:316-660-7675
Practice Address - Fax:316-838-0231
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200430950AMedicaid
KS843998OtherBLUE CROSS BLUE SHIELD
KS843998OtherBLUE CROSS BLUE SHIELD