Provider Demographics
NPI:1952502585
Name:BANJAK, REBECCA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:BANJAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LINE ST
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-1234
Mailing Address - Country:US
Mailing Address - Phone:724-962-7100
Mailing Address - Fax:724-458-4550
Practice Address - Street 1:63 LINE ST
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-1234
Practice Address - Country:US
Practice Address - Phone:724-866-6763
Practice Address - Fax:724-962-7100
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0163151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical