Provider Demographics
NPI:1891380671
Name:MALAGESE, BIANCA ROSA (LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:ROSA
Last Name:MALAGESE
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:ROSA
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2785 CASON ST # 2
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2843
Mailing Address - Country:US
Mailing Address - Phone:765-446-4185
Mailing Address - Fax:
Practice Address - Street 1:2614 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2529
Practice Address - Country:US
Practice Address - Phone:930-204-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-19-36333103K00000X
KY252305103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst