MEDICARE: MAXINE LEOTA BANECKS 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

General Provider Information

NPI Number	:	1215182431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXINE LEOTA BANECKS LCSW

Provider Business Mailing Address
First Line	:	188 INVERNESS DR W
Second Line	:	SUITE 500
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4231 W 16TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-1335
Country	:	US
Telephone Number	:	303-629-3876
Fax Number	:	303-426-4949

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

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/21/2025

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