Provider Demographics
NPI:1861441123
Name:BANKS, CAROLE ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ELAINE
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 THEODORE DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-9162
Mailing Address - Country:US
Mailing Address - Phone:207-837-0538
Mailing Address - Fax:844-640-0624
Practice Address - Street 1:77 THEODORE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-9162
Practice Address - Country:US
Practice Address - Phone:207-837-0538
Practice Address - Fax:844-640-0624
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC73081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME226870099Medicaid