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Organization
IMPACT LCSW COUNSELING SERVICES, PC
Active
Organization
IMPACT LCSW COUNSELING SERVICES, PC
Active
Other names
IMPACT Counseling Services
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL A BRUNJES LCSW-R (CEO/CLINICAL DIRECTOR)
(631) 467-3181
Entity
Organization
Contact information
Practice address
2760 MIDDLE COUNTRY RD, SUITE 1, LAKE GROVE, NY 11755-2113
(631) 467-3181
(631) 467-3185
Mailing address
2760 MIDDLE COUNTRY RD, SUITE 1, LAKE GROVE, NY 11755-2113
(631) 467-3181
(631) 467-3185
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R043837-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02756912
—
NY
01
—
11569751
CAQH
NY
Enumeration date
07/19/2006
Last updated
08/22/2020
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