MEDICARE: MR. CLYDE E. VANWORTH MSW, LSW

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	101YP1600X	Pastoral Counselor
2	104100000X	Social Worker	44SL05395500	NJ

General Provider Information

NPI Number	:	1750599940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLYDE E. VANWORTH MSW, LSW

Provider Business Mailing Address
First Line	:	92 THREADLEAF TER
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-4355
Country	:	US
Telephone Number	:	609-747-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	24260 W MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-1908
Country	:	US
Telephone Number	:	609-298-6226
Fax Number	:

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

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	09/11/2025

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