Provider Demographics
NPI:1649026014
Name:SPECTRUM WELLNESS LLC
Entity type:Organization
Organization Name:SPECTRUM WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SHADE-MONUTEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D, LABA
Authorized Official - Phone:781-405-0111
Mailing Address - Street 1:182 MISHAWUM RD
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2431
Mailing Address - Country:US
Mailing Address - Phone:781-405-0111
Mailing Address - Fax:781-529-0423
Practice Address - Street 1:182 MISHAWUM RD
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2431
Practice Address - Country:US
Practice Address - Phone:781-405-0111
Practice Address - Fax:781-529-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty