Provider Demographics
NPI:1285298505
Name:WERTZ, STEVEN ROBERT (BCBA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:WERTZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GARDEN CTR STE 26
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1773
Mailing Address - Country:US
Mailing Address - Phone:720-328-9857
Mailing Address - Fax:
Practice Address - Street 1:80 GARDEN CTR STE 26
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1773
Practice Address - Country:US
Practice Address - Phone:720-328-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-03-1461103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst