Healthcare Provider Details

I. General information

NPI: 1629051149
Provider Name (Legal Business Name): SPECTRUM BEHAVIORAL MANAGEMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 HAIGHT AVE
POUGHKEEPSIE NY
12603-2464
US

IV. Provider business mailing address

20 DAVIS AVE
POUGHKEEPSIE NY
12603-2408
US

V. Phone/Fax

Practice location:
  • Phone: 845-485-3500
  • Fax: 845-485-8780
Mailing address:
  • Phone: 845-485-3500
  • Fax: 845-485-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. YOGESH M. SHINGALA
Title or Position: CHAIRMAN
Credential: LCSWR
Phone: 845-485-3500