Provider Demographics
NPI:1235949595
Name:BANKS, CLARISSA (LMSW)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:DELFINA
Other - Last Name:PEDRAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2115 KRAMER LN.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:512-978-9672
Mailing Address - Fax:512-776-0452
Practice Address - Street 1:2115 KRAMER LN.
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-978-9672
Practice Address - Fax:512-776-0452
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66213171M00000X, 104100000X
TX16078172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker