Provider Demographics
NPI:1801774922
Name:BERTRAM, MATHEW
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:BERTRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7838 ALMOND DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9252
Mailing Address - Country:US
Mailing Address - Phone:317-903-0425
Mailing Address - Fax:
Practice Address - Street 1:1777 W STONES CROSSING RD STE 120
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7899
Practice Address - Country:US
Practice Address - Phone:317-810-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-25-460241106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician