1952502585 NPI number — MISS REBECCA ELIZABETH BANJAK LCSW

Table of content: MISS REBECCA ELIZABETH BANJAK LCSW (NPI 1952502585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952502585 NPI number — MISS REBECCA ELIZABETH BANJAK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANJAK
Provider First Name:
REBECCA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
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:
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:
1952502585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 S MERCER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARPSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16150-1309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
724-297-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 SNYDER RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-3432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-866-6763
Provider Business Practice Location Address Fax Number:
724-962-7100
Provider Enumeration Date:
05/30/2007

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: 1041C0700X , with the licence number:  CW016315 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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