| Elaine Banta Phd Pa | |
|
725 Na1a Elaine Banta Phd Pa Ste B106 Jupiter FL 33477 | |
| (561) 427-0144 | |
| (561) 747-0258 |
| Full Name | Elaine Banta Phd Pa |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 725 Na1a, Jupiter, Florida |
| Authorized Official Name and Position | Elaine Banta (PRESIDENT) |
| Authorized Official Contact | 5614270144 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elaine Banta Phd Pa 725 Na1a Elaine Banta Phd Pa Ste B106 Jupiter FL 33477 Ph: (561) 427-0144 | Elaine Banta Phd Pa 725 Na1a Elaine Banta Phd Pa Ste B106 Jupiter FL 33477 Ph: (561) 427-0144 |
| NPI Number | 1235184920 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 12/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235184920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY4354FL (Florida) | Primary |
| 103TC0700X | Psychologist - Clinical | NC1669NC (North Carolina) | Secondary |
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