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NPI Code Detail

MEDICARE: INTEGRATED PSYCHOLOGICAL SERVICES A PROFESSIONAL CORPORATION

MEDICARE: INTEGRATED PSYCHOLOGICAL SERVICES A PROFESSIONAL CORPORATION
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
1103TP2701XGroup Psychotherapy Psychologist

General Provider Information

NPI Number : 1588639918
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED PSYCHOLOGICAL SERVICES A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 6546
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92607-6546
Country : US
Telephone Number : 949-365-0309
Fax Number : 949-831-2439
Provider Business Practice Location Address
First Line : 28202 CABOT RD STE 300
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-1249
Country : US
Telephone Number : 949-280-3585
Fax Number : 949-831-2439
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARIA M. PETROSINO
Credential : PH.D.
Telephone Number : 949-280-3585
Provider Enumeration Date : 02/20/2006
Last Update Date : 02/09/2023

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Directions to “INTEGRATED PSYCHOLOGICAL SERVICES A PROFESSIONAL CORPORATION ” Practice Location

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