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General NPI Number Information
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NPI Number | 1366697963
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Entity Type | Organization
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Legal Business Name | SPECTRUM OF PSYCHIATRIC AND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 556 N. LEAVITT RD.
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City | AMHERST
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State | OH
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Zip | 44001
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Country | US
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Telephone | 440-985-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 556 N. LEAVITT RD.
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City | AMHERST
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State | OH
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Zip | 44001
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Country | US
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Telephone | 440-985-7777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURIE JO POLUBINSKY
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Credential | M.D.
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Telephone | 440-985-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 35.090420
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License Number State | OH
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