Provider Demographics
NPI:1164556726
Name:SPECTRUM YOUTH AND FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:SPECTRUM YOUTH AND FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-864-7423
Mailing Address - Street 1:31 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4347
Mailing Address - Country:US
Mailing Address - Phone:802-864-7423
Mailing Address - Fax:802-660-0576
Practice Address - Street 1:84 PINE ST FL 2
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4441
Practice Address - Country:US
Practice Address - Phone:802-864-7423
Practice Address - Fax:833-857-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT28311OtherBLUE CROSS BLUE SHIELD
VT1006363Medicaid