| Spectrum Behavioral Pc | |
|
30 Buxton Farm Rd Suite140 Stamford CT 06905-1224 | |
| (203) 612-7512 | |
| (203) 930-3655 |
| Full Name | Spectrum Behavioral Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 30 Buxton Farm Rd, Stamford, Connecticut |
| Authorized Official Name and Position | Sunil Saxena (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2036127511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Behavioral Pc 30 Buxton Farm Rd Suite140 Stamford CT 06905-1224 Ph: (203) 612-7512 | Spectrum Behavioral Pc 30 Buxton Farm Rd Suite140 Stamford CT 06905-1224 Ph: (203) 612-7512 |
| NPI Number | 1457636383 |
|---|---|
| Provider Enumeration Date | 10/11/2011 |
| Last Update Date | 01/30/2012 |
| Medicare PECOS PAC ID | 0840466488 |
|---|---|
| Medicare Enrollment ID | O20120103000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457636383 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 3117 (Connecticut) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 043723 (Connecticut) | Primary |
| Provider Name | Sunil Saxena |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346259637 PECOS PAC ID: 7012928997 Enrollment ID: I20060505000892 |
| Provider Name | Eri Kubota |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578082897 PECOS PAC ID: 5597021139 Enrollment ID: I20171114002756 |
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