Provider Demographics
NPI:1609868256
Name:NOELLE, ALBERT TOBIAS II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:TOBIAS
Last Name:NOELLE
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:TOBY
Other - Middle Name:
Other - Last Name:NOELLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW,LMHC
Mailing Address - Street 1:PO BOX 6459
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46904-6459
Mailing Address - Country:US
Mailing Address - Phone:765-453-7422
Mailing Address - Fax:765-453-3773
Practice Address - Street 1:702 WEST ALTO ROAD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6459
Practice Address - Country:US
Practice Address - Phone:765-453-7422
Practice Address - Fax:765-453-3773
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001764A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100154150AMedicaid
IND69625Medicare UPIN
IN100154150AMedicaid