Healthcare Provider Details

I. General information

NPI: 1366697963
Provider Name (Legal Business Name): SPECTRUM OF PSYCHIATRIC AND PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 N. LEAVITT RD.
AMHERST OH
44001
US

IV. Provider business mailing address

556 N. LEAVITT RD.
AMHERST OH
44001
US

V. Phone/Fax

Practice location:
  • Phone: 440-985-7777
  • Fax:
Mailing address:
  • Phone: 440-985-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number35.090420
License Number StateOH

VIII. Authorized Official

Name: DR. LAURIE JO POLUBINSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 440-985-7777