Healthcare Provider Details

I. General information

NPI: 1790360337
Provider Name (Legal Business Name): DARREN WILLIAM WADSWORTH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S FAIRFIELD RD # A106
LAYTON UT
84041-7105
US

IV. Provider business mailing address

650 W SOUTH TEMPLE APT A300
SALT LAKE CITY UT
84104-1031
US

V. Phone/Fax

Practice location:
  • Phone: 801-874-3535
  • Fax:
Mailing address:
  • Phone: 801-907-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11275797-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: