Provider Demographics
NPI:1932233954
Name:BANAITIS, DANIEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:BANAITIS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 OLYMPIC BLVD APT 141
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3958
Mailing Address - Country:US
Mailing Address - Phone:310-775-1521
Mailing Address - Fax:424-238-8694
Practice Address - Street 1:12100 WILSHIRE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7140
Practice Address - Country:US
Practice Address - Phone:310-775-1521
Practice Address - Fax:424-238-8694
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
CAMFC44732106H00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346520459OtherBILLING NPI
495555OtherMHN
600719446OtherMAGELLAN GROUP MIS
600726290OtherMAGELLAN