Individual provider Active NPI

Marta Cybulak, MA, LCPC

  • Professional Counselor
  • St Charles, IL
National Provider Identifier
1760810295
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
178008090 Issued in IL
Practice address
3833 E Main St # 1039
St Charles, IL 60174-2424
Phone
(773) 615-6278
NPI assigned
Oct 18, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 178008090 IL
Professional Counselor 101YP2500X 178008090 IL Primary

Addresses

Primary practice location

3833 E Main St # 1039
St Charles, IL 60174-2424

Mailing address

4461 Whitehall LN
Algonquin, IL 60102-6205
Phone (773) 615-6278

Other names 1

  • Marta Sakowska Former name

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
178008090ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Mind Care Wellness Center CurrentSince Mar 13, 2022 Accepting new patients

Locations

360 Town Plaza Ave
Ste 315
Ponte Vedra Beach, FL 32081

3833 E Main St
#1039
St Charles, IL 60174
Phone (773) 615-6278

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": "1382054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1760810295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4461 WHITEHALL LN",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601026205",
            "telephone_number": "773-615-6278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 E MAIN ST # 1039",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742424",
            "telephone_number": "773-615-6278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CYBULAK",
        "first_name": "MARTA",
        "credential": "MA, LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-18",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178008090",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178008090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARTA",
            "last_name": "SAKOWSKA",
            "credential": "MA, LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.