Healthcare Provider Details

I. General information

NPI: 1730781022
Provider Name (Legal Business Name): IMPACT HEALTH PSYCH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 INDIAN RIVER RD STE C7
ORANGE CT
06477-3691
US

IV. Provider business mailing address

240 INDIAN RIVER RD STE C7
ORANGE CT
06477-3691
US

V. Phone/Fax

Practice location:
  • Phone: 203-497-3861
  • Fax:
Mailing address:
  • Phone: 203-497-3861
  • Fax: 203-298-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE MALERBA
Title or Position: DIRECTOR OF OPS
Credential:
Phone: 203-988-0766