Provider Demographics
NPI:1578512943
Name:BERTOTTI, MARY BETH (MA LMHC LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:BERTOTTI
Suffix:
Gender:F
Credentials:MA LMHC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4886
Mailing Address - Fax:317-859-8239
Practice Address - Street 1:610 E SOUTHPORT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8590
Practice Address - Country:US
Practice Address - Phone:317-783-8383
Practice Address - Fax:317-782-6929
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000544A101YM0800X
IN35000547A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
155074Medicare ID - Type Unspecified