Provider Demographics
NPI:1912132986
Name:BARTRAM, NEVAH JAN (MSW, LCSW, MS)
Entity Type:Individual
Prefix:MS
First Name:NEVAH
Middle Name:JAN
Last Name:BARTRAM
Suffix:
Gender:F
Credentials:MSW, LCSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:858-642-3177
Mailing Address - Fax:858-552-4315
Practice Address - Street 1:3350 LA JOLLA VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92161
Practice Address - Country:US
Practice Address - Phone:858-642-3177
Practice Address - Fax:858-552-4315
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker