MEDICARE: RAVEN BEHAVIOR ANALYSIS, 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	:	1942164025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVEN BEHAVIOR ANALYSIS, LLC

Provider Business Mailing Address
First Line	:	2501 CHATHAM RD STE 5966
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:	786-848-8979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 CHATHAM RD STE 5966
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:	786-848-8979
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND CLINICAL DIRECTOR
Name	:	ANAIS ROSIN
Credential	:	BCBA
Telephone Number	:	786-848-8979

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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