Healthcare Provider Details

I. General information

NPI: 1467804310
Provider Name (Legal Business Name): ELIZABETH SORGIUS M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH FOLMSBEE M.A., BCBA

II. Dates (important events)

Enumeration Date: 07/04/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date: 05/13/2017
Reactivation Date: 05/07/2026

III. Provider practice location address

1148 E 58TH ST
INDIANAPOLIS IN
46220-2647
US

IV. Provider business mailing address

1148 E 58TH ST
INDIANAPOLIS IN
46220-2647
US

V. Phone/Fax

Practice location:
  • Phone: 774-287-5454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-18788
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: