Provider Demographics
NPI:1881732949
Name:INTEGRATED SELF IMAGE SYSTEMS, INC.
Entity type:Organization
Organization Name:INTEGRATED SELF IMAGE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MSW
Authorized Official - Phone:858-450-3210
Mailing Address - Street 1:9255 TOWNE CENTRE DR
Mailing Address - Street 2:STE 370
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3033
Mailing Address - Country:US
Mailing Address - Phone:858-450-3210
Mailing Address - Fax:858-458-9767
Practice Address - Street 1:9255 TOWNE CENTRE DR
Practice Address - Street 2:STE 370
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3033
Practice Address - Country:US
Practice Address - Phone:858-450-3210
Practice Address - Fax:858-458-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS13789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty