Basic Information
| Provider Information | |||||||||
| NPI: | 1134519523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANIEWICZ | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 W 8TH AVE STE I | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194061349 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1010 W 8TH AVE STE I | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194061349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563460005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2015 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC005164 | PA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103G00000X | PS018515 | PA | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.