Provider Demographics
NPI:1790801884
Name:BIANCA, MARY BERNADETTE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BERNADETTE
Last Name:BIANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:BERNADETTE
Other - Last Name:RISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3142 VISTA WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3619
Mailing Address - Country:US
Mailing Address - Phone:760-967-7082
Mailing Address - Fax:760-967-1465
Practice Address - Street 1:3142 VISTA WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3619
Practice Address - Country:US
Practice Address - Phone:760-967-7082
Practice Address - Fax:760-967-1465
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker