Michelle Marie Wortham, LCSW | |
905 Burnside Ave Apt C19, East Hartford, CT 06108-2719 | |
(959) 222-8548 | |
Not Available |
Full Name | Michelle Marie Wortham |
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Gender | Female |
Speciality | Social Worker - Clinical |
Location | 905 Burnside Ave Apt C19, East Hartford, Connecticut |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1316584956 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | 10836 (Connecticut) | Primary |
Entity Name | New Provenance Counseling Center, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1457949687 PECOS PAC ID: 3476934126 Enrollment ID: O20220713001166 |
Mailing Address | Practice Location Address |
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Michelle Marie Wortham, LCSW 905 Burnside Ave Apt C19, East Hartford, CT 06108-2719 Ph: (959) 222-8548 | Michelle Marie Wortham, LCSW 905 Burnside Ave Apt C19, East Hartford, CT 06108-2719 Ph: (959) 222-8548 |
Mrs. Sheila Ann Bridges-woods, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 588 Silver Ln, East Hartford, CT 06118 Phone: 860-770-8640 | |
Ms. Vanessa Marie Leone, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 7 Birchwood Rd, East Hartford, CT 06118 Phone: 860-214-2846 | |
Miss Nicole Salisbury, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 800 Connecticut Blvd, East Hartford, CT 06108 Phone: 860-622-5341 | |
Karl Stephen Wilson, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 98 Wakefield Cir # 98, East Hartford, CT 06118 Phone: 860-655-2429 | |
Nicole Osborne, Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 94 Conn Blvd, East Hartford, CT 06108 Phone: 860-610-6160 | |
Mrs. Ursula Ann Jackson, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 450 Forbes St, East Hartford, CT 06118 Phone: 860-622-5340 Fax: 860-622-5342 | |
Kelly Littlejohn Jr., LMSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 101 Clayton Rd, East Hartford, CT 06118 Phone: 860-752-5085 |