=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093336307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE THERAPY LCSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2020
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 MAPLE AVE STE 201
-----------------------------------------------------
City | SMITHTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11787-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-306-4284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 WEBSTER AVE
-----------------------------------------------------
City | LAKE RONKONKOMA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11779-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEFANIE STADLER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 631-682-7451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------