Individual
SOPHIA ELOISE MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
8762 LOUISIANA ST STE J, MERRILLVILLE, IN 46410-7190
(219) 472-0628
Mailing address
8762 LOUISIANA ST, MERRILLVILLE, IN 46410-7191
(219) 472-0628
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-46517
IN
Other
Enumeration date
12/28/2020
Last updated
01/22/2021
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