| Doctor Name: | MICHAEL BANIEWICZ |
| NPI Number: | 1134519523 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., L.P.C. |
| License Number: | PC005164 |
| Business Practice Address: | 250 Haddonfield Berlin Rd Suite 105 Gibbsboro, NJ - 080261228 |
| Business Phone Number: | 8563460005 |
| Business Fax Number: | |
| Mailing Address: | 250 Haddonfield Berlin Rd, Suite 105 GIBBSBORO |
| State: | NJ |
| Postal Code: | 080261228 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/23/2015 |
| NPI Last Update Date: | 01/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PC005164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |