Provider Demographics
NPI:1417600750
Name:BANULL, CHERYL ANN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:BANULL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:BANULL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:310 CRANE ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2915
Mailing Address - Country:US
Mailing Address - Phone:570-575-8358
Mailing Address - Fax:
Practice Address - Street 1:310 CRANE ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2915
Practice Address - Country:US
Practice Address - Phone:570-575-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool