Lawrence T. Wentworth, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301007769 Issued in MI

Practice address

11111 Hall Rd
Suite 303
Utica, MI 48317-5711

Phone

(586) 997-3153

Fax

(586) 997-4956

NPI assigned

Aug 19, 2005

Last updated

Apr 6, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wentworth and Associates PCGroup PAC ID 9537140819, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wentworth and Associates PC

  • Psychologist
  • Utica, MI
  • NPI 1306827191
  Medicare reassignment Care Compare group NPD Authorized official
• Wentworth and Associates, P.C.

  • Clinical Psychologist
  • Utica, MI
  • NPI 1356735468
  Authorized official Same address or phone
• Ann Sheridan Straky PH.D., P.C.

  • Psychologist
  • Utica, MI
  • NPI 1861682130
  NPD (past)

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238976000000",
    "number": "1346232998",
    "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 303",
            "city": "UTICA",
            "state": "MI",
            "postal_code": "483175711",
            "telephone_number": "586-997-3153",
            "fax_number": "586-997-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENTWORTH",
        "first_name": "LAWRENCE",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2009-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301007769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wallace Wellness Therapy & Performance LLC
• Lanee Arlett Wallace, OTR/L
• Michael Washburn, M.M., M.A., CSAT-C
• Wentworth and Associates PC
• Wentworth and Associates, P.C.
• Elzbieta Edyta Wisniewski, AGACNP-BC
• Jasmine Withers
• Brian Daniel Wummel, MA, LLPC
• Traci Yaldo
• Rachel Ellen Young

• Psychologist in Utica, MI
• Providers in Utica, MI by specialty
• Psychologist in Michigan

• 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; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.