Amy Stack Gustavson, MS, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

002405-1 Issued in NY

Practice address

251 Lafayette St FL 3
New York, NY 10012-4067

Phone

(212) 570-1693

NPI assigned

Aug 3, 2011

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312329600000",
    "number": "1629356977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 HILAIRE WAY",
            "city": "SEAFORD",
            "state": "NY",
            "postal_code": "117832710",
            "telephone_number": "718-352-2140",
            "fax_number": "718-352-2491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 LAFAYETTE ST FL 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100124067",
            "telephone_number": "212-570-1693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVSON",
        "first_name": "AMY",
        "middle_name": "STACK",
        "name_prefix": "Mrs.",
        "credential": "MS, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-03",
        "last_updated": "2011-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "002405-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Richard Guss, MD
• Ellen Gussaroff, LCSW, PH.D.
• Ann Marie Gustafson, MD
• Greta H. Gustafson, LCSW
• Danielle Alberte Gustama, NURSE PRACTITIONER
• Kiersten Danielle Gustavson, RN
• Ingrid Christina Gustavsson Mahjani
• Clare Gustavsson, LP
• Sabrina Gustin
• Gut Glow Health Dietetics and Nutrition Professional Corporation

• Mental Health Counselor in New York, NY
• Providers in New York, 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 Aug 3, 2011; 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.