Impact LCSW Counseling Services, PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R043837-1 Issued in NY

Legal business name

IMPACT LCSW COUNSELING SERVICES, PC

Practice address

2760 Middle Country Rd
Suite 1
Lake Grove, NY 11755-2113

Phone

(631) 467-3181

Fax

(631) 467-3185

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

Carol A Brunjes, LCSW-R

Title

Ceo/Clinical Director

Phone

(631) 467-3181

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• IMPACT Counseling Services Doing business as

Locations

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972522902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 MIDDLE COUNTRY RD",
            "address_2": "SUITE 1",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552113",
            "telephone_number": "631-467-3181",
            "fax_number": "631-467-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 MIDDLE COUNTRY RD",
            "address_2": "SUITE 1",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552113",
            "telephone_number": "631-467-3181",
            "fax_number": "631-467-3185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT LCSW COUNSELING SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRUNJES",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "631-467-3181",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R043837-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11569751",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02756912",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMPACT Counseling Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rosemarie Hughes, M.S., CCC/SLP
• Jake A Hunter, MD
• Barbara A. Ialacci-Pfeifer, D.C.
• Stephanie Lee Ihriskey
• Impact Counseling Services I, Inc.
• Lorraine Ann Ingraffia, R.N.
• Homer Joseph Torrevillas Inoferio
• Island Pulmonary and Critical Care PLLC
• Stacey Italiano, PT
• Mark J Jagust, M.D.

• Clinical Social Worker in Lake Grove, NY
• Providers in Lake Grove, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.