Provider Demographics
NPI:1285779694
Name:BANKS, RHODA (LCSW)
Entity type:Individual
Prefix:
First Name:RHODA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 FEDERAL RD
Mailing Address - Street 2:UNIT C-33
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2647
Mailing Address - Country:US
Mailing Address - Phone:203-775-6269
Mailing Address - Fax:203-740-7887
Practice Address - Street 1:246 FEDERAL RD
Practice Address - Street 2:UNIT C-33
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2647
Practice Address - Country:US
Practice Address - Phone:203-775-6269
Practice Address - Fax:203-740-7887
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004155104100000X
NYR038516-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004231601Medicaid
CT004231601Medicaid