Provider Demographics
NPI:1952873119
Name:NEWMAN, MADISON BAIN (BCBA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:BAIN
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:MORITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6540 W 400 N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46104-9418
Mailing Address - Country:US
Mailing Address - Phone:317-441-0249
Mailing Address - Fax:
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1635
Practice Address - Country:US
Practice Address - Phone:463-222-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-33103103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst