Provider Demographics
NPI:1437359502
Name:BANJANIN, NANCY SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUZANNE
Last Name:BANJANIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:482 N PIN OAK PL
Mailing Address - Street 2:#304
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5932
Mailing Address - Country:US
Mailing Address - Phone:407-310-1818
Mailing Address - Fax:
Practice Address - Street 1:1850 LEE RD
Practice Address - Street 2:SUITE 103, OFFICE #2
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2115
Practice Address - Country:US
Practice Address - Phone:407-310-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical