Provider Demographics
NPI:1184825549
Name:SHARMA, RUCHI (BCBA (LICENSED, IL))
Entity type:Individual
Prefix:MS
First Name:RUCHI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:
Credentials:BCBA (LICENSED, IL)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HOWARD ST APT 1812
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4058
Mailing Address - Country:US
Mailing Address - Phone:312-914-8208
Mailing Address - Fax:
Practice Address - Street 1:5801 MOUNT PLEASANT LN
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3944
Practice Address - Country:US
Practice Address - Phone:618-489-5102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL1-14-17778103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicare UPIN