Provider Demographics
NPI:1609366095
Name:BIANCAMANO, NICOLE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BIANCAMANO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:NICOLINE
Other - Middle Name:
Other - Last Name:BIANCAMANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:601 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8245
Mailing Address - Country:US
Mailing Address - Phone:718-329-5410
Mailing Address - Fax:718-329-5409
Practice Address - Street 1:601 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8245
Practice Address - Country:US
Practice Address - Phone:718-329-5410
Practice Address - Fax:718-329-5409
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0742601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical