Provider Demographics
NPI:1366933145
Name:BEHAVIORAL ANALYSIS LLC
Entity type:Organization
Organization Name:BEHAVIORAL ANALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:973-768-9274
Mailing Address - Street 1:48A LINN DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-3101
Mailing Address - Country:US
Mailing Address - Phone:973-768-9274
Mailing Address - Fax:
Practice Address - Street 1:48A LINN DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-3101
Practice Address - Country:US
Practice Address - Phone:973-768-9274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-17-27509103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1518458199OtherCMS