MEDICARE: ATLANTIC BEHAVIORAL HEALTH LLC

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1295617363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	124 KRAML DR
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-0303
Country	:	US
Telephone Number	:	630-631-9623
Fax Number	:	630-290-0522

Provider Business Practice Location Address
First Line	:	11555 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-5001
Country	:	US
Telephone Number	:	630-631-9623
Fax Number	:	630-290-0522

Authorized Official
Title or Position	:	BCBA
Name	:	MISS SHADEN KASSAR
Credential	:	BCBA
Telephone Number	:	630-631-9623

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	02/05/2026

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