Provider Demographics
NPI:1750599940
Name:VANWORTH, CLYDE E (MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:E
Last Name:VANWORTH
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 THREADLEAF TER
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4355
Mailing Address - Country:US
Mailing Address - Phone:609-747-0550
Mailing Address - Fax:
Practice Address - Street 1:24260 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1908
Practice Address - Country:US
Practice Address - Phone:609-298-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NJ44SL05395500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker