Provider Demographics
NPI:1376895250
Name:GENCO-MORRISON, BIANCA (LISW)
Entity Type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:
Last Name:GENCO-MORRISON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VENUS RD. WEST
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-0000
Mailing Address - Country:US
Mailing Address - Phone:505-832-5885
Mailing Address - Fax:505-281-7210
Practice Address - Street 1:17 VENUS RD. WEST
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015
Practice Address - Country:US
Practice Address - Phone:505-832-5885
Practice Address - Fax:505-281-7210
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06773104100000X
NM3006461041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool