Provider Demographics
NPI:1578839973
Name:SPECTRUM BEHAVIOR SERVICES, LLC
Entity Type:Organization
Organization Name:SPECTRUM BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-495-2411
Mailing Address - Street 1:443 17TH ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:885 BROADWAY
Practice Address - Street 2:#173
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3087
Practice Address - Country:US
Practice Address - Phone:215-495-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01062727103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty