Provider Demographics
NPI:1619338316
Name:BIANCO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BIANCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WINTERBERRY PL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-1978
Mailing Address - Country:US
Mailing Address - Phone:856-723-4199
Mailing Address - Fax:
Practice Address - Street 1:43 FERN LN
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9625
Practice Address - Country:US
Practice Address - Phone:609-567-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health