Provider Demographics
NPI:1972789212
Name:BANKS, JOAN MARY
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARY
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:MARY
Other - Last Name:HENNEBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:LITTLE DEER ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04650-0097
Mailing Address - Country:US
Mailing Address - Phone:207-348-6859
Mailing Address - Fax:
Practice Address - Street 1:1 JUNIPER LODGE LANE
Practice Address - Street 2:
Practice Address - City:LITTLE DEER ISLE
Practice Address - State:ME
Practice Address - Zip Code:04650-0097
Practice Address - Country:US
Practice Address - Phone:207-348-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist