Provider Demographics
NPI:1376600767
Name:FERRARO, BART (PHD HSPP)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:
Last Name:FERRARO
Suffix:
Gender:M
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1305
Mailing Address - Country:US
Mailing Address - Phone:317-941-2200
Mailing Address - Fax:317-941-2208
Practice Address - Street 1:2011 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1305
Practice Address - Country:US
Practice Address - Phone:317-941-2200
Practice Address - Fax:317-941-2208
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010510A103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN057945000OtherMAGELLAN
IN88448OtherCIGNA
IN000000271870OtherANTHEM BCBS
IN100068930Medicaid