Provider Demographics
NPI:1053187443
Name:SUNNYSIDE UP COUNSELING, LLC
Entity type:Organization
Organization Name:SUNNYSIDE UP COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LIPKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-596-0234
Mailing Address - Street 1:177 HUNTINGTON AVE STE 1703
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3153
Mailing Address - Country:US
Mailing Address - Phone:508-596-0234
Mailing Address - Fax:
Practice Address - Street 1:48 MARC AVENUE
Practice Address - Street 2:SUITE 1703
Practice Address - City:SOUTH BRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550
Practice Address - Country:US
Practice Address - Phone:508-596-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty