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NPI Code Detail

MEDICARE: VINCENT EZENWA DURU MS, BCBA

MEDICARE: VINCENT EZENWA DURU MS, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2172V00000XCommunity Health Worker
3103K00000XBehavior Analyst1-22-59222IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1172V00000XOTHERCACOMMUNITY HEALTH WORKER
21-22-59222OTHERBCBA CERT

General Provider Information

NPI Number : 1669719712
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT EZENWA DURU MS, BCBA
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 399 HOSPITAL LN
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47802-4394
Country : US
Telephone Number : 812-645-2308
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2013
Last Update Date : 07/02/2025

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