MEDICARE: DIANNA F. BANKS LICSW

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	113037	MA

General Provider Information

NPI Number	:	1639240427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNA F. BANKS LICSW

Provider Business Mailing Address
First Line	:	5 SHEPARD AVE
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-3417
Country	:	US
Telephone Number	:	781-588-3880
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 COLUMBIA RD
Second Line	:	STE 12
City	:	PEMBROKE
State	:	MA
Zip	:	02359-1842
Country	:	US
Telephone Number	:	781-925-2423
Fax Number	:	781-925-2650

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	06/29/2016

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