Provider Demographics
NPI:1033818034
Name:MOORE-BENGE, NOAH JAMES (BS BCABA)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:JAMES
Last Name:MOORE-BENGE
Suffix:
Gender:M
Credentials:BS BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-9744
Mailing Address - Country:US
Mailing Address - Phone:765-307-2104
Mailing Address - Fax:
Practice Address - Street 1:705 N ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-9744
Practice Address - Country:US
Practice Address - Phone:765-307-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0-23-14233103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst