MEDICARE: DR. SARAH MCINTOSH PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TF0200X	Forensic Psychologist	PSY26634	CA
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PSY26634	CA
3	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1396066684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH MCINTOSH PSY.D.

Provider Business Mailing Address
First Line	:	901 DOVE ST
Second Line	:	STE 150
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-3018
Country	:	US
Telephone Number	:	949-614-5719
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 DOVE ST
Second Line	:	STE 150
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-3018
Country	:	US
Telephone Number	:	949-614-5719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	08/29/2016

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