Healthcare Provider Details

I. General information

NPI: 1295748689
Provider Name (Legal Business Name): SPECTRUM PSYCHOTHERAPY CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MECHANIC ST
WINDSOR CT
06095-2545
US

IV. Provider business mailing address

30 MAPLE AVE
WINDSOR CT
06095-2922
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-7999
  • Fax: 860-688-0004
Mailing address:
  • Phone: 860-246-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER PENTA
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 860-246-7999