Provider Demographics
NPI:1326339227
Name:BANE, MARGIT (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGIT
Middle Name:
Last Name:BANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 S POMONA AVE UNIT D26
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-3428
Mailing Address - Country:US
Mailing Address - Phone:714-851-0263
Mailing Address - Fax:
Practice Address - Street 1:1631 S POMONA AVE UNIT D26
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-3428
Practice Address - Country:US
Practice Address - Phone:714-851-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 158201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical