Provider Demographics
NPI:1740837558
Name:WENTWORTH, EMILY MICHELLE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MICHELLE
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 COUNTY HWY 34
Mailing Address - Street 2:
Mailing Address - City:SCHENEVUS
Mailing Address - State:NY
Mailing Address - Zip Code:12155-2021
Mailing Address - Country:US
Mailing Address - Phone:646-265-3991
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1394
Practice Address - Country:US
Practice Address - Phone:844-255-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP101834101YM0800X
NY014211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health