Provider Demographics
NPI:1407158124
Name:EBANKS, ANETTE LUISA
Entity Type:Individual
Prefix:
First Name:ANETTE
Middle Name:LUISA
Last Name:EBANKS
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 1:3169 NW 91ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-3453
Mailing Address - Country:US
Mailing Address - Phone:305-696-2665
Mailing Address - Fax:
Practice Address - Street 1:3169 NW 91ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-3453
Practice Address - Country:US
Practice Address - Phone:305-696-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst