Provider Demographics
NPI:1386771400
Name:WERTZ, KAITRYN (LMHC)
Entity type:Individual
Prefix:
First Name:KAITRYN
Middle Name:
Last Name:WERTZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15096 115TH AVE N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-3508
Mailing Address - Country:US
Mailing Address - Phone:561-748-9512
Mailing Address - Fax:561-748-6543
Practice Address - Street 1:725 N HIGHWAY A1A
Practice Address - Street 2:BUILDING E, STE 203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4571
Practice Address - Country:US
Practice Address - Phone:561-748-9512
Practice Address - Fax:561-748-6543
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ129KOtherBCBS PROVIDER NUMBER