Healthcare Provider Details

I. General information

NPI: 1861312720
Provider Name (Legal Business Name): SOPHIA ISABELLA MORONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 CHARLESTOWN ROAD
NEW ALBANY IN
47150
US

IV. Provider business mailing address

5209 CLOVER RIDGE DRIVE
GREENVILLE IN
47124
US

V. Phone/Fax

Practice location:
  • Phone: 930-204-2414
  • Fax:
Mailing address:
  • Phone: 812-207-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: