Provider Demographics
NPI:1538644992
Name:BANAITIS, KRISTINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:BANAITIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:GRABYTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2016 MEADOW BROOK CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1317
Mailing Address - Country:US
Mailing Address - Phone:310-383-4297
Mailing Address - Fax:
Practice Address - Street 1:2016 MEADOW BROOK CT
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1317
Practice Address - Country:US
Practice Address - Phone:310-383-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW852081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical