Provider Demographics
NPI:1265950935
Name:SPECTRUM COUNSELING AND FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:SPECTRUM COUNSELING AND FAMILY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:BARBUTO
Authorized Official - Last Name:DEANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-966-6786
Mailing Address - Street 1:112 OLD CANAL WAY
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9688
Mailing Address - Country:US
Mailing Address - Phone:860-966-6786
Mailing Address - Fax:
Practice Address - Street 1:1 GRIST MILL LN
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2485
Practice Address - Country:US
Practice Address - Phone:860-966-6786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9517251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health