MEDICARE: CHERI WORTHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	172V00000X	Community Health Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1669559878	OTHER	CA	ART NPI NUMBER

General Provider Information

NPI Number	:	1346466901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERI WORTHAM

Provider Business Mailing Address
First Line	:	1617 E SAGINAW WAY
Second Line	:	SUITE #102
City	:	FRESNO
State	:	CA
Zip	:	93704-4458
Country	:	US
Telephone Number	:	559-274-0299
Fax Number	:	559-244-0328

Provider Business Practice Location Address
First Line	:	1617 E SAGINAW WAY
Second Line	:	SUITE #102
City	:	FRESNO
State	:	CA
Zip	:	93704-4458
Country	:	US
Telephone Number	:	559-274-0299
Fax Number	:	559-244-0328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	04/04/2013

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Directions to “ CHERI WORTHAM ” Practice Location

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