Bonnie Neidecker Soukup, LMHC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

004684 Issued in NY

Practice address

435 Main St Ste 5
Islip, NY 11751-3536

Phone

(631) 664-1582

NPI assigned

Oct 14, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 3, 2024 through Dec 3, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifeworks Mental Health Counseling, PLLC

  dba LifeWorks Mental Health Counseling

  • Community/Behavioral Health Agency
  • Islip, NY
  • NPI 1659980845
  NPD (past)

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

{
    "created_epoch": "1539475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539475200000",
    "number": "1558837880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 13TH ST",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117164420",
            "telephone_number": "636-697-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 MAIN ST STE 5",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513536",
            "telephone_number": "631-664-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUKUP",
        "first_name": "BONNIE",
        "middle_name": "NEIDECKER",
        "credential": "LMHC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-14",
        "last_updated": "2018-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "004684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Smith-Starace, BS
• Elizabeth C Smith, CCC-SLP
• Grace England Smithers
• Scott A Snyder, DC
• Feliz Solis, PT
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• South Bay Physical Therapy and Sports Rehabilitation PC (Great South Bay Physical Therapy & Sports Rehabilitation PC)
• South Shore Neurologic Associates P.C.
• Donna Spada, LCSW
• Spectrum Care Companions, LLC

• Mental Health Counselor in Islip, NY
• Providers in Islip, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.