NPIMap

Organization Active NPI

Impact Psychological Services PLLC

  • Community/Behavioral Health Agency
  • Beacon, NY
National Provider Identifier
1538837414
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
IMPACT PSYCHOLOGICAL SERVICES PLLC
Practice address
1183 North Ave
Beacon, NY 12508-1700
Phone
(917) 300-1332
NPI assigned
Sep 3, 2021
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tracy A Prout, PHDNPI 1437462389
Title
Co-Owner/Managing Member
Phone
(917) 596-2958

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1183 North Ave
Beacon, NY 12508-1700

Mailing address

1183 North Ave
Beacon, NY 12508-1700
Phone (917) 596-2958

Other practice location 1

408 Mamaroneck Ave
Mamaroneck, NY 10543-2613
Phone (917) 300-1332

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tracyprout@impact-psych.com Direct

National Provider Directory

National Provider Directory

Locations

1183 North Ave
Beacon, NY 12508
Phone (917) 300-1332

1183 North Ave
Ste 4
Beacon, NY 12508
Phone (914) 355-9920

257 Mamaroneck Ave
Ste 207
Mamaroneck, NY 10543

408 Mamaroneck Ave
Mamaroneck, NY 10543
Phone (862) 781-0501

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1538837414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1183 NORTH AVE",
            "city": "BEACON",
            "state": "NY",
            "postal_code": "125081700",
            "telephone_number": "917-596-2958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1183 NORTH AVE",
            "city": "BEACON",
            "state": "NY",
            "postal_code": "125081700",
            "telephone_number": "917-300-1332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "408 Mamaroneck Ave",
            "address_purpose": "LOCATION",
            "city": "Mamaroneck",
            "state": "NY",
            "postal_code": "105432613",
            "country_code": "US",
            "telephone_number": "917-300-1332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-03",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "PROUT",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CO-OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "917-596-2958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tracyprout@impact-psych.com",
            "affiliation": "N",
            "endpointDescription": "HIPAA compliant email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1183 North Ave Ste 4",
            "city": "Beacon",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125081700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Beacon, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.