Individual
CLARISSA WENTWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1321 RESEARCH PARK DR, BEAVERCREEK, OH 45432-2851
(937) 427-3837
Mailing address
452 W MARKET ST, XENIA, OH 45385-2815
(937) 376-8700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I1000187
OH
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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