Individual
MICHAEL BANIEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1010 W 8TH AVE STE I, KING OF PRUSSIA, PA 19406-1349
(856) 346-0005
Mailing address
1010 W 8TH AVE STE I, KING OF PRUSSIA, PA 19406-1349
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
PC005164
PA
103G00000X
Clinical Neuropsychologist
Primary
PS018515
PA
Other
Enumeration date
01/23/2015
Last updated
11/22/2021
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