Provider Demographics
NPI:1770168692
Name:INSIGHT PSYCHIATRY PLLC
Entity type:Organization
Organization Name:INSIGHT PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:520-276-6326
Mailing Address - Street 1:13855 E BEATTY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SONOITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85637-6514
Mailing Address - Country:US
Mailing Address - Phone:480-798-1903
Mailing Address - Fax:
Practice Address - Street 1:25 EL CAMINO REAL STE 4
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2800
Practice Address - Country:US
Practice Address - Phone:720-694-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ361524Medicaid