MEDICARE: STEPHANY J WORTHINGTON

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	101Y00000X	Counselor	483384	NY

General Provider Information

NPI Number	:	1801233168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANY J WORTHINGTON

Provider Business Mailing Address
First Line	:	13750 STATE ROUTE 193
Second Line	:
City	:	ELLISBURG
State	:	NY
Zip	:	13636-2108
Country	:	US
Telephone Number	:	315-846-9253
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 BRIDGE ST
Second Line	:
City	:	CARTHAGE
State	:	NY
Zip	:	13619-1360
Country	:	US
Telephone Number	:	315-493-3300
Fax Number	:	315-493-3306

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

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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Directions to “ STEPHANY J WORTHINGTON ” Practice Location

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