Provider Demographics
NPI:1588804843
Name:INTEGRATIVE PSYCHIATRY INC
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:941-371-7997
Mailing Address - Street 1:3392 MAGIC OAK LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1822
Mailing Address - Country:US
Mailing Address - Phone:941-379-7997
Mailing Address - Fax:941-379-7667
Practice Address - Street 1:3392 MAGIC OAK LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1822
Practice Address - Country:US
Practice Address - Phone:941-371-7997
Practice Address - Fax:941-379-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102322084P0800X
FLRN13479662363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4468Medicare PIN