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NPI Code Detail

MEDICARE: BETHANY BANAL

MEDICARE: BETHANY BANAL
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
1103TS0200XSchool PsychologistDC

General Provider Information

NPI Number : 1760811145
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY BANAL
Provider Business Mailing Address
First Line : 3815 FORT DR NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20016-1870
Country : US
Telephone Number : 202-939-2010
Fax Number :
Provider Business Practice Location Address
First Line : 3815 FORT DR NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20016-1870
Country : US
Telephone Number : 202-939-2010
Fax Number : 202-282-1116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2013
Last Update Date : 11/05/2013

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Directions to “ BETHANY BANAL ” Practice Location

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