1225120546 NPI number — MR. GREGORY CHARLES BANKS MA LPC NCC

Table of content: MR. GREGORY CHARLES BANKS MA LPC NCC (NPI 1225120546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225120546 NPI number — MR. GREGORY CHARLES BANKS MA LPC NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANKS
Provider First Name:
GREGORY
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC NCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225120546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 NORTH STREET
Provider Second Line Business Mailing Address:
SUITE 217
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-841-6574
Provider Business Mailing Address Fax Number:
860-606-9539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 NORTH STREET
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-841-6574
Provider Business Practice Location Address Fax Number:
860-606-9539
Provider Enumeration Date:
09/28/2006

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: 101YP2500X , with the licence number:  001450 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004263969 . This is a "HUSKY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 205483988 . This is a "TRICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 240001450CT01 . This is a "ANTHEM BC BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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