Provider Demographics
NPI:1932469400
Name:BANAS, TANYA M (LPC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:BANAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 JOHN DOWNEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2906
Mailing Address - Country:US
Mailing Address - Phone:860-826-1358
Mailing Address - Fax:860-229-8886
Practice Address - Street 1:55 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1728
Practice Address - Country:US
Practice Address - Phone:860-224-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002149101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor