Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3234 | NC |
Y | 103G00000X | Clinical Psychologist | 3234 | NC |
Y | 103TC0700X | Clinical Psychologist | 3234 | NC |
NPI | 1215027156 |
---|---|
Provider Name | Dr. Sammy F. Banawan |
First Address | Durham, NC 27705-3534 |
Second Address | Durham, NC 27705-3534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 06/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046X7 | BCBS PROVIDER NUMBER (01) | NC |