Provider Demographics
NPI:1366796005
Name:SUNRISE PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:SUNRISE PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-724-7220
Mailing Address - Street 1:26 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2012
Mailing Address - Country:US
Mailing Address - Phone:305-724-7220
Mailing Address - Fax:631-650-3816
Practice Address - Street 1:363 ROUTE 111 STE 102
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4750
Practice Address - Country:US
Practice Address - Phone:631-780-6804
Practice Address - Fax:631-780-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018315-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty