Provider Demographics
NPI:1154824555
Name:SPECTRUM THERAPY SERVICES
Entity Type:Organization
Organization Name:SPECTRUM THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVIVIO
Authorized Official - Suffix:
Authorized Official - Credentials:MS IN ED, PD IN ED
Authorized Official - Phone:631-385-3342
Mailing Address - Street 1:21 SWEET HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6530
Mailing Address - Country:US
Mailing Address - Phone:631-385-3342
Mailing Address - Fax:
Practice Address - Street 1:21 SWEET HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6530
Practice Address - Country:US
Practice Address - Phone:631-385-3342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine