Sara Camille Banegas – School Psychologist

Key facts

NPI: 1003397647
Entity type: Individual (NPI type 1)
Primary specialty: School Psychologist 103TS0200X
License: 550480E (WA)
Practice address: 5108 260TH St E
Graham, WA 98338-9609
Phone: (602) 653-1445
NPI assigned: Aug 22, 2018
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
550480E	WA	MD	School Psychologist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
School Psychologist	103TS0200X	550480E	WA	Yes

Addresses

Primary practice location

5108 260TH St E
Graham, WA 98338-9609

Mailing address

5636 A St
Tacoma, WA 98408-7505

Other practice location 1

6514 260th St E
Graham, WA 98338-9648
Phone (602) 653-1445

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2018.

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1003397647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5636 A ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984087505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5108 260TH ST E",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983389609",
            "telephone_number": "602-653-1445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6514 260th St E",
            "address_purpose": "LOCATION",
            "city": "Graham",
            "state": "WA",
            "postal_code": "983389648",
            "country_code": "US",
            "telephone_number": "602-653-1445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANEGAS",
        "first_name": "SARA",
        "middle_name": "CAMILLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-22",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "WA",
            "license": "550480E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Graham, WA

All providers in Graham, WA · School Psychologist in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.