Provider Demographics
NPI:1336936814
Name:DUZAN, ANDREW RAYMOND (RBT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RAYMOND
Last Name:DUZAN
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 E 200 N
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7854
Mailing Address - Country:US
Mailing Address - Phone:765-806-9369
Mailing Address - Fax:
Practice Address - Street 1:8063 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6001
Practice Address - Country:US
Practice Address - Phone:317-648-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-324089106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician