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NPI Code Detail

MEDICARE: MS. SHERVONNE BANKS LCSW, MSG

MEDICARE: MS. SHERVONNE BANKS LCSW, MSG
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
1104100000XSocial WorkerSC61177195WA
21041C0700XClinical Social Worker12104CT
31041C0700XClinical Social Worker121504CT
4305S00000XPoint of Service112160VA
51041C0700XClinical Social Worker0904014396VA

General Provider Information

NPI Number : 1033398003
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHERVONNE BANKS LCSW, MSG
Provider Business Mailing Address
First Line : 4410 CLAIBORNE SQ E STE 334
Second Line :
City : HAMPTON
State : VA
Zip : 23666-2074
Country : US
Telephone Number : 844-702-4357
Fax Number : 757-866-5572
Provider Business Practice Location Address
First Line : 4410 CLAIBORNE SQ E STE 334
Second Line :
City : HAMPTON
State : VA
Zip : 23666-2074
Country : US
Telephone Number : 844-702-4357
Fax Number : 757-866-5572
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2007
Last Update Date : 12/10/2022

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