Spectrum Psychological and Neurotherapy PC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

SPECTRUM PSYCHOLOGICAL AND NEUROTHERAPY PC

Practice address

4542 Bonney Rd Ste B
Virginia Beach, VA 23462

Phone

(757) 640-1882

Fax

(757) 640-0253

NPI assigned

Dec 11, 2015

Last updated

Aug 15, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carl Richard Ellis, ED.D.NPI 1821173519

Title

Owner/Ceo

Phone

(757) 640-1882

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carl Richard Ellis, ED.D.

  • Clinical Child & Adolescent Psychologist
  • Norfolk, VA
  • NPI 1821173519
  Medicare reassignment NPD Authorized official
• Lee Summer Phillips, APRN, PMHNP, BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Norfolk, VA
  • NPI 1831308964
  Medicare reassignment NPD
• Christopher Todd Jarosinski, RESIDENT IN COUNSELI

  • Mental Health Counselor
  • Virginia Beach, VA
  • NPI 1376115576
  NPD (past)
• Lori Ann Kroener, PH.D

  • Psychologist
  • Virginia Beach, VA
  • NPI 1346759727
  NPD (past)

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

{
    "created_epoch": "1449792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1407221716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4542 BONNEY RD STE B",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623867",
            "telephone_number": "757-640-1882",
            "fax_number": "757-640-0253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4542 BONNEY RD STE B",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23462",
            "telephone_number": "757-640-1882",
            "fax_number": "757-640-0253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4542 Bonney Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "23462",
            "country_code": "US",
            "telephone_number": "757-640-1882",
            "fax_number": "757-640-0253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECTRUM PSYCHOLOGICAL AND NEUROTHERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-11",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "757-640-1882",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam W Specht, MD
• Dena Specht, P.T.
• Special Event Providers of Emergency Medicine, Inc.
• Specialized Orthopaedic Services (Specialized)
• Joseph Speckhart, PTA
• Speech at the Beach, PLLC
• Ganna Spektor, PA
• Sherita Monet Speller
• Carol Spellman, LPN
• Kayla Nicole Spence

• Psychologist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.