Provider Demographics
NPI:1801356209
Name:BANKS, MONICA CLAUDINE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:CLAUDINE
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 1:6669 AUDUBON TRCE W
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-3003
Mailing Address - Country:US
Mailing Address - Phone:561-201-3126
Mailing Address - Fax:
Practice Address - Street 1:6669 AUDUBON TRCE W
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-3003
Practice Address - Country:US
Practice Address - Phone:561-201-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician