Provider Demographics
NPI:1235958968
Name:VICINITY THERAPY
Entity type:Organization
Organization Name:VICINITY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANOS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MA, PSYD
Authorized Official - Phone:732-655-4235
Mailing Address - Street 1:2105 LEXINGTON MEWS
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1348
Mailing Address - Country:US
Mailing Address - Phone:732-655-4235
Mailing Address - Fax:
Practice Address - Street 1:297 WESTWOOD DR STE 103
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3144
Practice Address - Country:US
Practice Address - Phone:732-655-4235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty