Caryn Margaret Banque, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY24416 Issued in CA

Practice address

2621 Capitol Ave
Sacramento, CA 95816-5920

Phone

(530) 383-3051

NPI assigned

Mar 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Newstart Medical Group Inc

  dba Blue Stone Health and Wellness

  • Rural Health Clinic/Center
  • Weimar, CA
  • NPI 1588072698
  Medicare reassignment NPD

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1477685253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 65",
            "city": "WEIMAR",
            "state": "CA",
            "postal_code": "957360065",
            "telephone_number": "530-383-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 CAPITOL AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165920",
            "telephone_number": "530-383-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANQUE",
        "first_name": "CARYN",
        "middle_name": "MARGARET",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY24416",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "H0501251418",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA STATE LICENSE",
            "identifier": "PSY24416",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latrice Banks
• Marisa Nicole Banks, PA-C
• Tylia Banks
• Willie Banks III
• Erikeysha Bannerman-Richter
• Nyuieko Celestina Bansah, CPHW
• Senam Bansah
• Renu Bansal, MD
• Riya Bansal
• Winston Bansale, CRNA

• Clinical Psychologist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.