NPIMap

Organization Active NPI

Spectrum Psychotherapy Centers, LLC

  • Clinical Psychologist
  • Windsor, CT
National Provider Identifier
1295748689
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SPECTRUM PSYCHOTHERAPY CENTERS, LLC
Practice address
41 Mechanic St
Windsor, CT 06095-2545
Phone
(860) 246-7999
Fax
(860) 688-0004
NPI assigned
Aug 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Penta, PSY.D.NPI 1720178049
Title
President
Phone
(860) 246-7999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

41 Mechanic St
Windsor, CT 06095-2545

Mailing address

30 Maple Ave
Windsor, CT 06095-2922
Phone (860) 246-7999

Other identifiers 3

IdentifierTypeStateIssuer
2490549OtherCTAETNA US HEALTHCARE
ANC1198OtherCTOXFORD HEALTH PLANS
252147OtherCTMHN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100920000491 CT Part B Supplier - Clinic/Group Practice 8921123589 Receives reassigned benefits from 2 practitioners
Practice locations: Windsor, CT

National Provider Directory

National Provider Directory

Locations

41 Mechanic St
Ste 1
Windsor, CT 06095
Phone (860) 246-7999

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412208000000",
    "number": "1295748689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MAPLE AVE",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060952922",
            "telephone_number": "860-246-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 MECHANIC ST",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060952545",
            "telephone_number": "860-246-7999",
            "fax_number": "860-688-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM PSYCHOTHERAPY CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2014-10-02",
        "status": "A",
        "authorized_official_last_name": "PENTA",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-246-7999",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "2490549",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "ANC1198",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "252147",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.