Provider Demographics
NPI:1780247213
Name:WORTHAM, JEANEE LA'TRESE (LMHC, LPC)
Entity type:Individual
Prefix:MRS
First Name:JEANEE
Middle Name:LA'TRESE
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-0071
Mailing Address - Country:US
Mailing Address - Phone:848-633-1203
Mailing Address - Fax:
Practice Address - Street 1:145 HUGUENOT ST STE 404
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5237
Practice Address - Country:US
Practice Address - Phone:914-355-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011249-01101YM0800X
NJ37PC00-14400101YP2500X
106S00000X
NY18098734-00101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician