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NPI Code Detail

MEDICARE: RAVEN JOHNSON

MEDICARE: RAVEN JOHNSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1497686802
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN JOHNSON
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5035
Country : US
Telephone Number : 470-650-8148
Fax Number : 470-650-8148
Provider Business Practice Location Address
First Line : 2389 OAK MYRTLE LN
Second Line :
City : WESLEY CHAPEL
State : FL
Zip : 33544-6328
Country : US
Telephone Number : 813-862-3743
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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