Provider Demographics
NPI:1255082046
Name:BANJANIN, SOMER LEIGH (LMHC)
Entity type:Individual
Prefix:
First Name:SOMER
Middle Name:LEIGH
Last Name:BANJANIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 TWISTING PINE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2634
Mailing Address - Country:US
Mailing Address - Phone:407-547-8939
Mailing Address - Fax:
Practice Address - Street 1:670 N ORLANDO AVE STE 103
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4465
Practice Address - Country:US
Practice Address - Phone:407-622-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health