Provider Demographics
NPI:1770476186
Name:BANGURA, ANN-MARIE
Entity type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:BANGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5214
Mailing Address - Country:US
Mailing Address - Phone:463-701-0909
Mailing Address - Fax:640-500-3096
Practice Address - Street 1:1061 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5214
Practice Address - Country:US
Practice Address - Phone:463-701-0909
Practice Address - Fax:640-500-3096
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-328803106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician