Provider Demographics
NPI:1194415489
Name:BANEGAS, KELVIN (LMSW)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:
Last Name:BANEGAS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2249
Mailing Address - Country:US
Mailing Address - Phone:516-469-2135
Mailing Address - Fax:
Practice Address - Street 1:99 WALL ST STE 1982
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-4301
Practice Address - Country:US
Practice Address - Phone:631-624-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health