Provider Demographics
NPI:1225120546
Name:BANKS, GREGORY CHARLES (MA LPC NCC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:CHARLES
Last Name:BANKS
Suffix:
Gender:M
Credentials:MA LPC NCC
Other - Prefix:
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Mailing Address - Street 1:57 NORTH STREET
Mailing Address - Street 2:SUITE 217
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:860-841-6574
Mailing Address - Fax:860-606-9539
Practice Address - Street 1:57 NORTH STREET
Practice Address - Street 2:SUITE 217
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:860-841-6574
Practice Address - Fax:860-606-9539
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004263969OtherHUSKY
CT205483988OtherTRICARE
CT240001450CT01OtherANTHEM BC BS