Provider Demographics
NPI:1386054229
Name:BANTHIN, DAVID C (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:BANTHIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 81ST ST
Mailing Address - Street 2:APT. 620
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7210
Mailing Address - Country:US
Mailing Address - Phone:917-207-8739
Mailing Address - Fax:
Practice Address - Street 1:101 W 81ST ST
Practice Address - Street 2:APT. 620
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-7210
Practice Address - Country:US
Practice Address - Phone:917-207-8739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020191103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical