Healthcare Provider Details

I. General information

NPI: 1225256878
Provider Name (Legal Business Name): LAURI SIBBLIES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-68 164TH ST
JAMAICA NY
11432
US

IV. Provider business mailing address

450 HUNGRY HARBOR RD
VALLEY STREAM NY
11581-3637
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-3225
  • Fax: 718-883-6193
Mailing address:
  • Phone: 917-294-0899
  • Fax: 718-334-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number052793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: