Organization
IMPACT PSYCHOLOGICAL SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY A PROUT PHD (CO-OWNER/MANAGING MEMBER)
(917) 596-2958
Entity
Organization
Contact information
Practice address
1183 NORTH AVE, BEACON, NY 12508-1700
(917) 300-1332
Mailing address
1183 NORTH AVE, BEACON, NY 12508-1700
(917) 596-2958
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/03/2021
Last updated
03/01/2024
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