Individual
IRENEUSZ BANACZYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LCDC
Contact information
Practice address
1706 NUECES ST, AUSTIN, TX 78701-1108
(512) 803-8763
Mailing address
5507A FERNVIEW RD., AUSTIN, TX 78745-4521
(512) 803-8763
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12677
TX
1041C0700X
Clinical Social Worker
Primary
104111
TX
Other
Enumeration date
09/21/2016
Last updated
08/31/2023
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