Provider Demographics
NPI:1093973596
Name:INTEGRATIVE PSYCHOLOGICAL SERVICES FOR THE FAMILY
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL SERVICES FOR THE FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:PIERALDI
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:787-460-3031
Mailing Address - Street 1:165 PUEBLO VIEJO TORRE 1 SUITE 401
Mailing Address - Street 2:CENTRO INTERNACIONAL DE MERCADEO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-460-3031
Mailing Address - Fax:787-279-1708
Practice Address - Street 1:PALACIOS DE MARBELLA # 1147
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-218-5002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2781261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)