Provider Demographics
NPI:1326716861
Name:BANAYAN, MENUCHAH M
Entity Type:Individual
Prefix:
First Name:MENUCHAH
Middle Name:M
Last Name:BANAYAN
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 1:588 E NEW YORK AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4514
Mailing Address - Country:US
Mailing Address - Phone:305-783-6621
Mailing Address - Fax:
Practice Address - Street 1:1398 CARROLL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4404
Practice Address - Country:US
Practice Address - Phone:305-783-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health