Provider Demographics
NPI:1578974499
Name:AGASSI, BIANCA (PHD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:AGASSI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:AGASSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2400 SPRING WATER DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1875 NW CORPORATE BLVD STE 270
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8550
Practice Address - Country:US
Practice Address - Phone:561-997-0821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA94727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)