Provider Demographics
NPI:1659630689
Name:BANNISTER, BARI J
Entity Type:Individual
Prefix:
First Name:BARI
Middle Name:J
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 STARK ROAD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822
Mailing Address - Country:US
Mailing Address - Phone:518-654-2398
Mailing Address - Fax:518-654-7361
Practice Address - Street 1:96 STARK RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-2300
Practice Address - Country:US
Practice Address - Phone:518-654-2398
Practice Address - Fax:518-654-7361
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health