Healthcare Provider Details

I. General information

NPI: 1871305797
Provider Name (Legal Business Name): CAREY PATRICK WERTZ LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KERRI KARMEN PATRICK WERTZ

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 CONGRESS ST STE 2
PORTLAND ME
04102-2169
US

IV. Provider business mailing address

1577 CONGRESS ST STE 2
PORTLAND ME
04102-2169
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-5093
  • Fax:
Mailing address:
  • Phone: 207-662-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC7066
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC7066
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: