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1932233954

NPI Code Detail

MEDICARE: MR. DANIEL BANAITIS LMFT

MEDICARE: MR. DANIEL BANAITIS LMFT

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		CA
2	106H00000X	Marriage & Family Therapist	MFC44732	CA
3	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1346520459	OTHER		BILLING NPI
2	495555	OTHER		MHN
3	600719446	OTHER		MAGELLAN GROUP MIS
4	600726290	OTHER		MAGELLAN

General Provider Information

NPI Number	:	1932233954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL BANAITIS LMFT

Provider Business Mailing Address
First Line	:	2001 OLYMPIC BLVD APT 141
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-3958
Country	:	US
Telephone Number	:	310-775-1521
Fax Number	:	424-238-8694

Provider Business Practice Location Address
First Line	:	12100 WILSHIRE BLVD STE 800
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7140
Country	:	US
Telephone Number	:	310-775-1521
Fax Number	:	424-238-8694

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	11/18/2020

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Directions to “ MR. DANIEL BANAITIS LMFT” Practice Location

Language	Start Address	Practice Location

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