Provider Demographics
NPI:1902079890
Name:BANTA, HELEN E (CSW)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:E
Last Name:BANTA
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E HILLSBORO BLVD
Mailing Address - Street 2:102
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3521
Mailing Address - Country:US
Mailing Address - Phone:561-302-4923
Mailing Address - Fax:561-732-1686
Practice Address - Street 1:805 E HILLSBORO BLVD
Practice Address - Street 2:102
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3521
Practice Address - Country:US
Practice Address - Phone:561-302-4923
Practice Address - Fax:561-732-1686
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 54451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical