Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 5571 | OH |
Y | 103T00000X | Psychologist | 5571 | OH |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 5571 | OH |
N | 103TH0004X | Health Psychologist | 5571 | OH |
NPI | 1528113727 |
---|---|
Provider Name | Gerard A Banez |
First Address | Cleveland, OH 44104-3815 |
Second Address | Cleveland, OH 44104-3815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2167319 | (05) | OH |
S86203 | (02) | OH |