Provider Demographics
NPI:1508202953
Name:SPECTRUM BEHAVIORAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SPECTRUM BEHAVIORAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZITO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-353-5168
Mailing Address - Street 1:345 STONE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2424
Mailing Address - Country:US
Mailing Address - Phone:407-353-5168
Mailing Address - Fax:
Practice Address - Street 1:345 STONE ISLAND RD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:FL
Practice Address - Zip Code:32725-2424
Practice Address - Country:US
Practice Address - Phone:407-353-5168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3595103K00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty