Provider Demographics
NPI:1871784835
Name:BANACH, ELIZABETH MCDANIEL (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MCDANIEL
Last Name:BANACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:LAYBURN
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:274 ST JOHNS PLACE
Mailing Address - Street 2:APARTMENT 4C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5668
Mailing Address - Country:US
Mailing Address - Phone:646-228-9053
Mailing Address - Fax:
Practice Address - Street 1:228 EAST 45TH ST
Practice Address - Street 2:SUITE 1801
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3390
Practice Address - Country:US
Practice Address - Phone:646-228-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0758911104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker