Organization
ELAINE BANTA PHD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELAINE BANTA PHD (PRESIDENT)
(561) 427-0144
Entity
Organization
Contact information
Practice address
725 NA1A, ELAINE BANTA PHD PA STE B106, JUPITER, FL 33477
(561) 427-0144
(561) 747-0258
Mailing address
725 NA1A, ELAINE BANTA PHD PA STE B106, JUPITER, FL 33477
(561) 427-0144
(561) 747-0258
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
NC1669NC
NC
103TC0700X
Clinical Psychologist
Primary
PY4354FL
FL
Other
Enumeration date
05/23/2006
Last updated
12/05/2011
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