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General NPI Number Information
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NPI Number | 1801774922
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Entity Type | Individual
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Provider Name | MATHEW BERTRAM
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Gender | Male
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 1777 W STONES CROSSING RD STE 120
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City | GREENWOOD
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State | IN
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Zip | 46143-7899
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Country | US
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Telephone | 317-810-6297
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Fax |
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Provider Business Mailing Address
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Address Line | 7838 ALMOND DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9252
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Country | US
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Telephone | 317-903-0425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-460241
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License Number State | IN
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