Provider Demographics
NPI:1881145084
Name:WERTZ, SOPHIA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:WERTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 OMNI LN
Mailing Address - Street 2:306
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5424
Mailing Address - Country:US
Mailing Address - Phone:443-310-8829
Mailing Address - Fax:
Practice Address - Street 1:3049 CLEVELAND AVE
Practice Address - Street 2:269
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7041
Practice Address - Country:US
Practice Address - Phone:239-689-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health