Provider Demographics
NPI:1962785055
Name:BANKS, MANAIRYA
Entity type:Individual
Prefix:MS
First Name:MANAIRYA
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 1:1328 SOUTHERN AVE SE STE 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4689
Mailing Address - Country:US
Mailing Address - Phone:202-562-6252
Mailing Address - Fax:202-562-6552
Practice Address - Street 1:1328 SOUTHERN AVE SE STE 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-562-6252
Practice Address - Fax:202-562-6552
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500787981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical