Provider Demographics
NPI:1942782438
Name:BANKS, BONNIE KINGSBURY
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:KINGSBURY
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BEAVER DAM RD # 1
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1326
Mailing Address - Country:US
Mailing Address - Phone:508-333-6708
Mailing Address - Fax:
Practice Address - Street 1:3 BEAVER DAM RD # 1
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1326
Practice Address - Country:US
Practice Address - Phone:508-333-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1140981041C0700X
MA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No253Z00000XAgenciesIn Home Supportive Care