Provider Demographics
NPI:1932350105
Name:INTEGRATED PSYCHIATRIC SERVICES INC
Entity type:Organization
Organization Name:INTEGRATED PSYCHIATRIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANSONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-483-0469
Mailing Address - Street 1:100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2365
Mailing Address - Country:US
Mailing Address - Phone:203-234-0365
Mailing Address - Fax:
Practice Address - Street 1:100 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2365
Practice Address - Country:US
Practice Address - Phone:203-234-0365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100000200Medicare PIN