Eric M. Banagay, LISW, LADAC
Individual provider Active NPI Clinical Social Worker · Clovis, NM
NPI 1780883264 · NPPES record last updated May 15, 2015
Key facts
- NPI
- 1780883264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- I-06885 (NM)
- Practice address
- 921 E 21St St
Suite D
Clovis, NM 88101-4443 - Phone
- (575) 762-0212
- Fax
- (575) 762-0660
- NPI assigned
- Jul 13, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Consulting Psychological Services, PA
Practice addresses (Care Compare)
921 E 21St St
Suite D
Clovis, NM 88101-4443
Phone (575) 762-0212
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090113000629 | NM | Practitioner - Clinical Social Worker | 5698838902 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0119781 | NM | MD | Addiction (Substance Use Disorder) Counselor |
| I-06885 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Consulting Psychological Services, PA | Current |
Accepting new patients | |
| Karen Higgins Niles Inc | Past | Accepting new patients |
Locations
921 E 21st St
Ste D
Clovis, NM 88101
Phone (505) 762-0212
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I-06885 | NM | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0119781 | NM |
Addresses
Primary practice location
921 E 21St St
Suite D
Clovis, NM 88101-4443
Mailing address
921 E 21St St
Suite D
Clovis, NM 88101-4443
Phone (575) 762-0212
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13683527 | Medicaid | NM |
Other providers in Clovis, NM
- Janet Lynn Baker-Davis
- Lewie Evan Baker
- Seth Sebastian Baker
- Sidney Alexis Baker
- Sylvia Baltazar
- Monica Banuelos
- Kirsten Barber
- Molly Kiernan Barbieri
- Edie Barela
- Cambree Bargas
All providers in Clovis, NM · Clinical Social Worker in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.