Provider Demographics
NPI:1346599289
Name:WERTZBERGER, PAUL G (LCSW, PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:WERTZBERGER
Suffix:
Gender:M
Credentials:LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 REAM AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2539
Mailing Address - Country:US
Mailing Address - Phone:831-586-0065
Mailing Address - Fax:
Practice Address - Street 1:1005 REAM AVE
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2539
Practice Address - Country:US
Practice Address - Phone:831-586-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS134931041C0700X
CAPSY27351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical