Healthcare Provider Details

I. General information

NPI: 1588639918
Provider Name (Legal Business Name): INTEGRATED PSYCHOLOGICAL SERVICES A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28202 CABOT RD STE 300
LAGUNA NIGUEL CA
92677-1249
US

IV. Provider business mailing address

PO BOX 6546
LAGUNA NIGUEL CA
92607-6546
US

V. Phone/Fax

Practice location:
  • Phone: 949-280-3585
  • Fax: 949-831-2439
Mailing address:
  • Phone: 949-365-0309
  • Fax: 949-831-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA M. PETROSINO
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 949-280-3585