Provider Demographics
NPI:1629389291
Name:BANNON, JAMES F JR (MA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:BANNON
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LINTON BLVD
Mailing Address - Street 2:147-B
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:561-573-4877
Mailing Address - Fax:
Practice Address - Street 1:100 E LINTON BLVD
Practice Address - Street 2:# 147-B
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3327
Practice Address - Country:US
Practice Address - Phone:561-573-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health