Healthcare Provider Details

I. General information

NPI: 1669286514
Provider Name (Legal Business Name): ANDREAS GEORGE SACRIPANTE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date: 02/05/2025
Reactivation Date: 09/15/2026

III. Provider practice location address

2 CORACI BLVD
SHIRLEY NY
11967-4833
US

IV. Provider business mailing address

1117 OCEAN AVE
BAY SHORE NY
11706-2741
US

V. Phone/Fax

Practice location:
  • Phone: 631-387-4907
  • Fax:
Mailing address:
  • Phone: 631-891-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015675
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: