Healthcare Provider Details

I. General information

NPI: 1295906287
Provider Name (Legal Business Name): ALISON ELIZABETH WENTWORTH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 04/03/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG /RAF LAKENHEATH UNIT 5115
APO AE
09461
GB

IV. Provider business mailing address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-238-1482
  • Fax:
Mailing address:
  • Phone: 314-238-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC10878
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number53931
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: