Provider Demographics
NPI:1891850020
Name:BANKS, GALE (APRN)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PARK ST CONNECTICUT MENTAL HEALTH CENTER
Mailing Address - Street 2:OFFICE OF CARE MANAGEMENT
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-974-7417
Mailing Address - Fax:203-974-7413
Practice Address - Street 1:34 PARK ST
Practice Address - Street 2:CONNECTICUT MENTAL HEALTH CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-974-7417
Practice Address - Fax:203-974-7413
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAPRN 002814363LP0808X
CTRNE33398363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500001199Medicare ID - Type UnspecifiedFIRST COAST