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General NPI Number Information
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NPI Number | 1528113727
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Entity Type | Individual
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Provider Name | GERARD A BANEZ PHD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 2801 MARTIN LUTHER KING JR DR
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City | CLEVELAND
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State | OH
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Zip | 44104-3815
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Country | US
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Telephone | 216-448-6253
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Fax | 216-448-6207
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Provider Business Mailing Address
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Address Line | 2801 MARTIN LUTHER KING JR DR
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City | CLEVELAND
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State | OH
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Zip | 44104-3815
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Country | US
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Telephone | 216-448-6253
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Fax | 216-448-6207
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 5571
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 5571
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5571
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License Number State | OH
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