Provider Demographics
NPI:1972783256
Name:BANKS, REGINALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:
Last Name:BANKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1021
Mailing Address - Country:US
Mailing Address - Phone:267-679-2215
Mailing Address - Fax:
Practice Address - Street 1:4232 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1021
Practice Address - Country:US
Practice Address - Phone:267-679-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA015203103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling