Provider Demographics
NPI:1083103923
Name:NOGA, JAMES PATRICK (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:NOGA
Suffix:
Gender:M
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21635 N DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-9577
Mailing Address - Country:US
Mailing Address - Phone:520-840-5562
Mailing Address - Fax:
Practice Address - Street 1:21635 N DIAMOND DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-9577
Practice Address - Country:US
Practice Address - Phone:520-840-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000332103K00000X, 103K00000X
AZ332103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-16-22346OtherBCBA CERTIFICATE
AZ088661Medicaid