Healthcare Provider Details

I. General information

NPI: 1114682630
Provider Name (Legal Business Name): THE SPECTRUM CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MARLTON PIKE E STE J49
CHERRY HILL NJ
08003-4106
US

IV. Provider business mailing address

2901 WATERFORD DR
CINNAMINSON NJ
08077-4438
US

V. Phone/Fax

Practice location:
  • Phone: 856-313-5619
  • Fax: 888-496-4170
Mailing address:
  • Phone: 856-313-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD KOSER
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD
Phone: 856-313-5619