Healthcare Provider Details

I. General information

NPI: 1578426185
Provider Name (Legal Business Name): MARIE H. BANCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST
STONY BROOK NY
11790-1946
US

IV. Provider business mailing address

25 MAIN ST
STONY BROOK NY
11790-1946
US

V. Phone/Fax

Practice location:
  • Phone: 631-675-6992
  • Fax: 631-675-6772
Mailing address:
  • Phone: 631-675-6992
  • Fax: 631-675-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARIE H BANCES
Title or Position: OWNER
Credential: LCSW
Phone: 631-675-6992