Provider Demographics
NPI:1467900803
Name:BANKS, CARLY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 MAIN ST BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3206
Mailing Address - Country:US
Mailing Address - Phone:410-973-2211
Mailing Address - Fax:443-782-0350
Practice Address - Street 1:10026 MAIN ST BLDG 1
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3206
Practice Address - Country:US
Practice Address - Phone:410-973-2211
Practice Address - Fax:443-782-0350
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12312101YM0800X
MD233321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23332OtherLICENSE