Provider Demographics
NPI:1033725510
Name:MCDANIEL, BIANCA (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 47 BOX 153
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09470-0002
Mailing Address - Country:US
Mailing Address - Phone:203-560-9169
Mailing Address - Fax:
Practice Address - Street 1:1652 MERIDEN RD APT 22
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3922
Practice Address - Country:US
Practice Address - Phone:203-560-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty