1871784835 NPI number — MS. ELIZABETH MCDANIEL BANACH LCSW

Table of content: MS. ELIZABETH MCDANIEL BANACH LCSW (NPI 1871784835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871784835 NPI number — MS. ELIZABETH MCDANIEL BANACH LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANACH
Provider First Name:
ELIZABETH
Provider Middle Name:
MCDANIEL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDANIEL
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
LAYBURN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871784835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
274 ST JOHNS PLACE
Provider Second Line Business Mailing Address:
APARTMENT 4C
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11238-5668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-228-9053
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 EAST 45TH ST
Provider Second Line Business Practice Location Address:
SUITE 1801
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-3390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-228-9053
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  0758911 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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