Provider Demographics
NPI:1417510975
Name:DALENBERG, ANNAH (BCBA)
Entity Type:Individual
Prefix:MS
First Name:ANNAH
Middle Name:
Last Name:DALENBERG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1235
Mailing Address - Country:US
Mailing Address - Phone:317-849-5437
Mailing Address - Fax:317-436-8911
Practice Address - Street 1:13431 OLD MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7101
Practice Address - Country:US
Practice Address - Phone:317-573-5437
Practice Address - Fax:317-436-8911
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-18-33853103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst