Healthcare Provider Details

I. General information

NPI: 1912818907
Provider Name (Legal Business Name): KEVIN SUSTAD MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ADAMS ST E
EAST ISLIP NY
11730-1616
US

IV. Provider business mailing address

15 ADAMS ST E
EAST ISLIP NY
11730-1616
US

V. Phone/Fax

Practice location:
  • Phone: 516-216-9372
  • Fax: 844-987-0439
Mailing address:
  • Phone: 516-216-9372
  • Fax: 844-987-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN MICHAEL SUSTAD
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 516-941-7504