NPIMap

Organization Active NPI

Wentworth and Associates PC

  • Psychologist
  • Utica, MI
National Provider Identifier
1306827191
Registry record updated Apr 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301007769 Issued in MI
Legal business name
WENTWORTH AND ASSOCIATES PC
Practice address
11111 Hall Rd
Suite 400
Utica, MI 48317-5711
Phone
(586) 997-3153
Fax
(586) 997-4956
NPI assigned
Nov 8, 2005
Last updated
Apr 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lawrence T. Wentworth, PH.D.NPI 1346232998
Title
President
Phone
(586) 997-3153

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301007769 MI Primary

Addresses

Primary practice location

11111 Hall Rd
Suite 400
Utica, MI 48317-5711

Mailing address

11111 Hall Rd
Suite 303
Utica, MI 48317-5711
Phone (586) 997-3153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041117000078 MI Part B Supplier - Clinic/Group Practice 9537140819 Receives reassigned benefits from 19 practitioners
Practice locations: Utica, MI

National Provider Directory

National Provider Directory

Locations

11111 Hall Rd
Ste 303
Utica, MI 48317
Phone (586) 739-0902

11111 Hall Rd
Ste 400
Utica, MI 48317
Phone (586) 739-0902

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238976000000",
    "number": "1306827191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11111 HALL RD",
            "address_2": "SUITE 303",
            "city": "UTICA",
            "state": "MI",
            "postal_code": "483175711",
            "telephone_number": "586-997-3153",
            "fax_number": "586-997-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11111 HALL RD",
            "address_2": "SUITE 400",
            "city": "UTICA",
            "state": "MI",
            "postal_code": "483175711",
            "telephone_number": "586-997-3153",
            "fax_number": "586-997-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WENTWORTH AND ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2009-04-06",
        "status": "A",
        "authorized_official_last_name": "WENTWORTH",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-997-3153",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301007769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.