Provider Demographics
NPI:1780067645
Name:BANKS, BRIAN STEPHEN (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:STEPHEN
Last Name:BANKS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 RIVERSIDE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-4947
Mailing Address - Country:US
Mailing Address - Phone:781-427-7070
Mailing Address - Fax:781-427-7071
Practice Address - Street 1:28 RIVERSIDE DR STE 260
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-4947
Practice Address - Country:US
Practice Address - Phone:508-993-3000
Practice Address - Fax:508-993-3009
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291563163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health