Sunrise Park Psychotherapy LCSW PC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

SUNRISE PARK PSYCHOTHERAPY LCSW PC

Practice address

1228 Wantagh Ave Ste 111
Wantagh, NY 11793-2209

Phone

(516) 644-6495

Fax

(516) 324-3143

NPI assigned

May 2, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gina Marie Cubillos, LCSWNPI 1518391705

Title

Owner/Provider

Phone

(516) 644-6495

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gina Marie Cubillos, LCSW

  • Clinical Social Worker
  • Wantagh, NY
  • NPI 1518391705
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1376288530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 WANTAGH AVE STE 111",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932209",
            "telephone_number": "516-644-6495",
            "fax_number": "516-324-3143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 WANTAGH AVE STE 111",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932209",
            "telephone_number": "516-644-6495",
            "fax_number": "516-324-3143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE PARK PSYCHOTHERAPY LCSW PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-02",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A",
        "authorized_official_last_name": "CUBILLOS",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "516-644-6495",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH OPTIONS",
            "identifier": "1048692",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ANTHEM ID",
            "identifier": "NKN592",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Strom, LMSW
• Christine Sullivan, LMSW
• Christine Elizabeth Sullivan
• Donna M Sullivan, PT
• Teresa N Sullivan, OTR
• Nancy Sutherland, LCSW
• John D. Sweetland, PH.D.
• Karishma Syed, PHARMD.
• Lisa Anna Szambel, D.C.
• Kari Linne Tabag, LCSW-R

• Adult Mental Health Clinic/Center in Wantagh, NY
• Providers in Wantagh, NY by specialty
• Adult Mental Health Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.