Healthcare Provider Details

I. General information

NPI: 1508202953
Provider Name (Legal Business Name): SPECTRUM BEHAVIORAL SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 STONE ISLAND RD
ENTERPRISE FL
32725-2424
US

IV. Provider business mailing address

345 STONE ISLAND RD
ENTERPRISE FL
32725-2424
US

V. Phone/Fax

Practice location:
  • Phone: 407-353-5168
  • Fax:
Mailing address:
  • Phone: 407-353-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3595
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1-07-3595
License Number State

VIII. Authorized Official

Name: MS. TARA LOZITO
Title or Position: MANAGING MEMBER
Credential: BCBA
Phone: 407-353-5168