Provider Demographics
NPI:1326276312
Name:BANKS, LE ANDREA (LCSWC)
Entity type:Individual
Prefix:MS
First Name:LE ANDREA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 SAINT JOHNS BLUFF RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2682
Mailing Address - Country:US
Mailing Address - Phone:301-801-4626
Mailing Address - Fax:
Practice Address - Street 1:3545 SAINT JOHNS BLUFF RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2682
Practice Address - Country:US
Practice Address - Phone:301-801-4626
Practice Address - Fax:301-576-4554
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0073321041C0700X
MD146361041C0700X
FLSW191481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD023734500Medicaid
MDX2910001OtherCAREFIRST BCBS
MD28438775OtherCIGNA
MD648076OtherVALUEOPTIONS MEDICAID
MDX2910001OtherCAREFIRST BCBS
MD648076OtherVALUEOPTIONS MEDICAID
MD000444811OtherUNITED HEALTHCARE/UBH