Provider Demographics
NPI:1174484844
Name:ACTIVE PSYCHOLOGY AND WELLNESS
Entity type:Organization
Organization Name:ACTIVE PSYCHOLOGY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:914-261-9295
Mailing Address - Street 1:18934 PORTERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1877
Mailing Address - Country:US
Mailing Address - Phone:914-261-9295
Mailing Address - Fax:
Practice Address - Street 1:1750 MONOCACY BLVD STE A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5151
Practice Address - Country:US
Practice Address - Phone:914-261-9295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty