Ireneusz Banaczyk, LCSW, LCDC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

104111 Issued in TX

Practice address

1706 Nueces St
Austin, TX 78701-1108

Phone

(512) 803-8763

NPI assigned

Sep 21, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1336697168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5507A FERNVIEW RD.",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787454521",
            "telephone_number": "512-803-8763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 NUECES ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787011108",
            "telephone_number": "512-803-8763"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5507A Fernview Rd",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787452717",
            "country_code": "US",
            "telephone_number": "512-803-8763",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7756 Northcross Dr Ste 203",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787571725",
            "country_code": "US",
            "telephone_number": "812-803-8763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANACZYK",
        "first_name": "IRENEUSZ",
        "credential": "LCSW, LCDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-21",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "12677",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "104111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Austin, TX
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.