Healthcare Provider Details

I. General information

NPI: 1891611059
Provider Name (Legal Business Name): LUMINA COMMUNITY PSYCHOTHERAPY, LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9035 52ND AVE APT 3
ELMHURST NY
11373-4034
US

IV. Provider business mailing address

418 BROADWAY # 6572
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 718-722-0332
  • Fax:
Mailing address:
  • Phone: 718-722-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. GLORIA SANCHEZ
Title or Position: OWNER
Credential: LCSW
Phone: 646-675-5904