Provider Demographics
NPI:1275815227
Name:MOORE, CASEY N (BCBA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:N
Last Name:MOORE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12726 HAMILTON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5422
Mailing Address - Country:US
Mailing Address - Phone:317-249-2242
Mailing Address - Fax:317-249-2248
Practice Address - Street 1:12726 HAMILTON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5422
Practice Address - Country:US
Practice Address - Phone:317-249-2242
Practice Address - Fax:317-249-2248
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1118439103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst