Individual
DR. BENJAMIN BANISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1218 MASSACHUSETTS AVE, SECOND FLOOR, CAMBRIDGE, MA 02138
(617) 855-2711
(617) 855-3730
Mailing address
78 JUNCTION SQUARE DR, CONCORD, MA 01742-3049
(978) 254-0123
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
8748
MA
Other
Enumeration date
08/31/2007
Last updated
05/15/2018
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