Individual provider Active NPI

Karen Gisela Sandoval, LMSW

  • Mental Health Counselor
  • Islip, NY
National Provider Identifier
1609304419
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
094920-1 Issued in NY
Practice address
401 Main St Ste 108
Islip, NY 11751-3560
Phone
(631) 446-1950
Fax
(631) 446-1952
NPI assigned
May 24, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 094920-1 NY Primary

Addresses

Primary practice location

401 Main St Ste 108
Islip, NY 11751-3560

Mailing address

401 Main St Ste 108
Islip, NY 11751-3560
Phone (631) 446-1950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
094920-1NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
West Islip Youth Enrichment Services Incorporated PastSince Jul 24, 2022 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1609304419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 MAIN ST STE 108",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513560",
            "telephone_number": "631-446-1950",
            "fax_number": "631-446-1952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MAIN ST STE 108",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513560",
            "telephone_number": "631-446-1950",
            "fax_number": "631-446-1952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "KAREN",
        "middle_name": "GISELA",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "094920-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Islip, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.