Provider Demographics
NPI:1023215142
Name:CAMBRIDGE, BARTLEY ALLEN (LCSW)
Entity type:Individual
Prefix:MR
First Name:BARTLEY
Middle Name:ALLEN
Last Name:CAMBRIDGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 ALLISON POINTE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4368
Mailing Address - Country:US
Mailing Address - Phone:317-554-4220
Mailing Address - Fax:317-554-4220
Practice Address - Street 1:8470 ALLISON POINTE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4368
Practice Address - Country:US
Practice Address - Phone:317-554-4220
Practice Address - Fax:317-554-4220
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000109A101YA0400X
FLSW17800101YM0800X, 1041C0700X
IL1490250421041C0700X
IN34004012A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116999100Medicaid