Provider Demographics
NPI:1154697456
Name:INTEGRATED PSYCHOLOGICAL SERVICES CSP
Entity type:Organization
Organization Name:INTEGRATED PSYCHOLOGICAL SERVICES CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-961-3600
Mailing Address - Street 1:201 CALLE GAUTIER BENITEZ
Mailing Address - Street 2:CONSOLIDATED MEDICAL PLAZA SUITE 012
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5527
Mailing Address - Country:US
Mailing Address - Phone:787-961-3600
Mailing Address - Fax:787-961-3601
Practice Address - Street 1:201 CALLE GAUTIER BENITEZ
Practice Address - Street 2:CONSOLIDATED MEDICAL PLAZA OFFICE 307A
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5527
Practice Address - Country:US
Practice Address - Phone:787-961-3600
Practice Address - Fax:787-961-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty