Healthcare Provider Details

I. General information

NPI: 1639760259
Provider Name (Legal Business Name): IMPACT HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS TOWN CIR STE 103
EWING NJ
08638-1962
US

IV. Provider business mailing address

350 S BROAD ST APT 305
TRENTON NJ
08608-2525
US

V. Phone/Fax

Practice location:
  • Phone: 973-953-9780
  • Fax:
Mailing address:
  • Phone: 862-333-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE NARKAUS
Title or Position: SCHOOL PSYCHOLOGIST
Credential: PSYD
Phone: 862-333-8230