1053598797 NPI number — MRS. COURTNEY REBECCA AGARWAL BCBA

Table of content: MRS. COURTNEY REBECCA AGARWAL BCBA (NPI 1053598797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053598797 NPI number — MRS. COURTNEY REBECCA AGARWAL BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGARWAL
Provider First Name:
COURTNEY
Provider Middle Name:
REBECCA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIERMAN
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
REBECCA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053598797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16414 SOUTHPARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46074-8396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-815-5501
Provider Business Mailing Address Fax Number:
317-399-7935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16414 SOUTHPARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46074-8396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-815-5501
Provider Business Practice Location Address Fax Number:
317-399-7935
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-11-9389 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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