Provider Demographics
NPI:1518151430
Name:BANKS, JEROLYN FAITH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEROLYN
Middle Name:FAITH
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16242 CHANDLER PL
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-7251
Mailing Address - Country:US
Mailing Address - Phone:985-215-1218
Mailing Address - Fax:
Practice Address - Street 1:16242 CHANDLER PL
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-7251
Practice Address - Country:US
Practice Address - Phone:985-215-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA75051041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1884065Medicaid
MS05903840Medicaid