Provider Demographics
NPI:1770520116
Name:SPECTRUM PSYCHOLOGY SERVICES, PLLC
Entity type:Organization
Organization Name:SPECTRUM PSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-978-8294
Mailing Address - Street 1:16108 E EMERALD DR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-5424
Mailing Address - Country:US
Mailing Address - Phone:516-978-8294
Mailing Address - Fax:
Practice Address - Street 1:16108 E EMERALD DR UNIT 204
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-5424
Practice Address - Country:US
Practice Address - Phone:516-978-8294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
NY013294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02773311Medicaid