Healthcare Provider Details

I. General information

NPI: 1649537192
Provider Name (Legal Business Name): JEREMY KEVIN WENTZ LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 06/01/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HOSPITAL PLAZA UNITED SUMMIT CENTER INC
CLARKSBURG WV
26301
US

IV. Provider business mailing address

504 EMILY DR # 1028
CLARKSBURG WV
26301-5507
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-5661
  • Fax: 304-623-2180
Mailing address:
  • Phone: 304-627-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberDP00944022
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: