Provider Demographics
NPI:1871305797
Name:PATRICK WERTZ, CAREY (LCPC)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:PATRICK WERTZ
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:KARMEN
Other - Last Name:PATRICK WERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1577 CONGRESS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2169
Mailing Address - Country:US
Mailing Address - Phone:207-662-5093
Mailing Address - Fax:
Practice Address - Street 1:1577 CONGRESS ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2169
Practice Address - Country:US
Practice Address - Phone:207-662-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7066101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional