Provider Demographics
NPI:1740802941
Name:MARCHBANKS, JOHNATHAN JAY (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:JAY
Last Name:MARCHBANKS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FOURSCORE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4807
Mailing Address - Country:US
Mailing Address - Phone:618-744-4015
Mailing Address - Fax:
Practice Address - Street 1:6 EAGLE CTR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1945
Practice Address - Country:US
Practice Address - Phone:618-206-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YA0400X, 172V00000X, 1041C0700X
101YP1600X, 1041C0700X, 1041S0200X, 374700000X
IL103K00000X, 1041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No172V00000XOther Service ProvidersCommunity Health Worker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374700000XNursing Service Related ProvidersTechnician