Provider Demographics
NPI:1154455913
Name:BERTRAM, BURT G (EDD)
Entity Type:Individual
Prefix:DR
First Name:BURT
Middle Name:G
Last Name:BERTRAM
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6346
Mailing Address - Country:US
Mailing Address - Phone:407-426-8088
Mailing Address - Fax:407-426-0552
Practice Address - Street 1:525 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6346
Practice Address - Country:US
Practice Address - Phone:407-426-8088
Practice Address - Fax:407-426-0552
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH863101YM0800X
FLMT145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist