Provider Demographics
NPI:1932220803
Name:BERTRAM, CHRISTIE CORMAN (PSYD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:CORMAN
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2802
Mailing Address - Country:US
Mailing Address - Phone:502-425-1633
Mailing Address - Fax:
Practice Address - Street 1:118 N CHADWICK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2802
Practice Address - Country:US
Practice Address - Phone:502-425-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical