Provider Demographics
NPI:1336697168
Name:BANACZYK, IRENEUSZ (LCSW, LCDC)
Entity Type:Individual
Prefix:
First Name:IRENEUSZ
Middle Name:
Last Name:BANACZYK
Suffix:
Gender:M
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507A FERNVIEW RD.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4521
Mailing Address - Country:US
Mailing Address - Phone:512-803-8763
Mailing Address - Fax:
Practice Address - Street 1:1706 NUECES ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1108
Practice Address - Country:US
Practice Address - Phone:512-803-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12677101YA0400X
TX1041111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)