Individual
BANNET AGESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
139 LEOPARD RD, BERWYN, PA 19312-1809
(215) 839-8769
Mailing address
1041 W BRIDGE ST # B5, PHOENIXVILLE, PA 19460-4342
(104) 159-3016
(610) 415-1656
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC018904
PA
Other
Enumeration date
06/21/2021
Last updated
11/11/2025
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