Healthcare Provider Details

I. General information

NPI: 1891380671
Provider Name (Legal Business Name): BIANCA ROSA MALAGESE LBA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIANCA ROSA COLEMAN

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/29/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 CHARLESTOWN RD
NEW ALBANY IN
47150-2529
US

IV. Provider business mailing address

2785 CASON ST # 2
LAFAYETTE IN
47904-2843
US

V. Phone/Fax

Practice location:
  • Phone: 930-204-2414
  • Fax:
Mailing address:
  • Phone: 765-446-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36333
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number252305
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: