Provider Demographics
NPI:1982473385
Name:BANOS, MAYBETH
Entity Type:Individual
Prefix:
First Name:MAYBETH
Middle Name:
Last Name:BANOS
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 1:26255 SW 144TH AVE APT 412
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5672
Mailing Address - Country:US
Mailing Address - Phone:786-205-1931
Mailing Address - Fax:
Practice Address - Street 1:26255 SW 144TH AVE APT 412
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5672
Practice Address - Country:US
Practice Address - Phone:786-205-1931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB521540718221103TR0400X, 171M00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No171M00000XOther Service ProvidersCase Manager/Care Coordinator