Provider Demographics
NPI:1093235608
Name:BIANCO, VICTOR VITO (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:VITO
Last Name:BIANCO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24920 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2057
Mailing Address - Country:US
Mailing Address - Phone:917-680-9052
Mailing Address - Fax:718-352-2706
Practice Address - Street 1:24920 57TH AVE
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2057
Practice Address - Country:US
Practice Address - Phone:917-680-9052
Practice Address - Fax:718-352-2706
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24055-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical