Provider Demographics
NPI:1851360093
Name:BANIGAN, RAE LORAINE (PH D CCC SLP)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:LORAINE
Last Name:BANIGAN
Suffix:
Gender:F
Credentials:PH D CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CHRISTINE ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-2206
Mailing Address - Country:US
Mailing Address - Phone:413-283-9240
Mailing Address - Fax:
Practice Address - Street 1:7 CHRISTINE ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-2206
Practice Address - Country:US
Practice Address - Phone:413-283-9240
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASPL61235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0370983Medicaid
MA662501OtherHARVARD PILGRIM LIMITED H
MASP0004OtherBLUE CROSS BLUE SHIELD MA