Organization
SUNRISE PARK PSYCHOTHERAPY LCSW PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA MARIE CUBILLOS LCSW (OWNER/PROVIDER)
(516) 644-6495
Entity
Organization
Contact information
Practice address
1228 WANTAGH AVE STE 111, WANTAGH, NY 11793-2209
(516) 644-6495
(516) 324-3143
Mailing address
1228 WANTAGH AVE STE 111, WANTAGH, NY 11793-2209
(516) 644-6495
(516) 324-3143
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1048692
BEACON HEALTH OPTIONS
NY
01
—
NKN592
BCBS ANTHEM ID
NY
Enumeration date
05/02/2022
Last updated
05/02/2022
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