Provider Demographics
NPI:1417003971
Name:BANCES, MARIE HELEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:HELEN
Last Name:BANCES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:HELEN
Other - Last Name:RACZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:104 UNIVERSITY HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-246-6201
Mailing Address - Fax:
Practice Address - Street 1:290 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:917-951-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0537211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker