Healthcare Provider Details

I. General information

NPI: 1780067645
Provider Name (Legal Business Name): BRIAN STEPHEN BANKS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 RIVERSIDE DR STE 260
PEMBROKE MA
02359-4947
US

IV. Provider business mailing address

28 RIVERSIDE DR STE 260
PEMBROKE MA
02359-4947
US

V. Phone/Fax

Practice location:
  • Phone: 508-993-3000
  • Fax: 508-993-3009
Mailing address:
  • Phone: 781-427-7070
  • Fax: 781-427-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2291563
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2291563
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: