Provider Demographics
NPI:1346611076
Name:BANKS, GLYNIS
Entity type:Individual
Prefix:
First Name:GLYNIS
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 COMMANDANTS WAY
Mailing Address - Street 2:APT. 411
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-4000
Mailing Address - Country:US
Mailing Address - Phone:215-313-6570
Mailing Address - Fax:
Practice Address - Street 1:325 COMMANDANTS WAY
Practice Address - Street 2:APT. 411
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-4000
Practice Address - Country:US
Practice Address - Phone:215-313-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131685104100000X
NY095796104100000X
MD21227104100000X, 1041C0700X
PASW1314851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical