Provider Demographics
NPI:1124762455
Name:INTEGRATIVE PSYCHOLOGICAL PROFESSIONAL SERVICE, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL PROFESSIONAL SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-579-5728
Mailing Address - Street 1:2 NELSON LN
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1109
Mailing Address - Country:US
Mailing Address - Phone:718-541-6453
Mailing Address - Fax:
Practice Address - Street 1:3 E EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5101
Practice Address - Country:US
Practice Address - Phone:845-579-5728
Practice Address - Fax:845-845-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty