Diari Marcus Banigo
Individual provider Active NPI Clinical Social Worker · Baltimore, MD
NPI 1801192083 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1801192083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 100778 (CA)
- Practice address
- 113 E 25TH St
First Floor
Baltimore, MD 21218-5248 - Phone
- (410) 900-3144
- NPI assigned
- Feb 4, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, DC
- 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 |
|---|---|---|---|---|
| I20210728003824 | CA | Practitioner - Clinical Social Worker | 1254635576 |
Reassigns benefits to 1 organization Practice locations: Fresno, CA |
| I20230911002801 | DC | Practitioner - Clinical Social Worker | 1254635576 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100778 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Clinical | Current |
Accepting new patients |
| Banigo Behavioral Health Group PHD | Clinical | Current | Accepting new patients |
| Grow Healthcare Group PC | Clinical | Current |
Accepting new patients |
| Aspire Counseling Services | Past | Accepting new patients |
Locations
99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | |||
| Clinical Social Worker | 1041C0700X | 100778 | CA | Yes |
Addresses
Primary practice location
113 E 25TH St
First Floor
Baltimore, MD 21218-5248
Mailing address
P. O. Box 805
Bel Air, MD 21014
Phone (410) 900-3147
Other providers in Baltimore, MD
- Robert Bangura
- Salamatu Bangura
- Erik Banh
- Ivona M Banham
- Kahlo Baniadam
- Ashley Banini
- Temitayo Banjo
- Kimberly A Bank
- Jeffrey M. Banker
- Matthew Bankert
All providers in Baltimore, MD · Clinical Social Worker in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.