Provider Demographics
NPI:1396066684
Name:MCINTOSH, SARAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:901 DOVE ST
Mailing Address - Street 2:STE 150
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3018
Mailing Address - Country:US
Mailing Address - Phone:949-614-5719
Mailing Address - Fax:
Practice Address - Street 1:901 DOVE ST
Practice Address - Street 2:STE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3018
Practice Address - Country:US
Practice Address - Phone:949-614-5719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26634103TF0200X, 103TA0400X
103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral