MEDICARE: BENITA BANKS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	5067	LA

General Provider Information

NPI Number	:	1225815244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENITA BANKS LCSW

Provider Business Mailing Address
First Line	:	5510 LAFAYE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-6340
Country	:	US
Telephone Number	:	504-559-8082
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 LAFAYE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-6340
Country	:	US
Telephone Number	:	504-559-8082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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