Provider Demographics
NPI:1134630007
Name:BIANCA, RALPH (PHD, LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:BIANCA
Suffix:
Gender:M
Credentials:PHD, LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OLD SPRINGFIELD AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1129
Mailing Address - Country:US
Mailing Address - Phone:908-312-2019
Mailing Address - Fax:
Practice Address - Street 1:220 ELMER ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2128
Practice Address - Country:US
Practice Address - Phone:973-615-3718
Practice Address - Fax:908-264-8631
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00269000101YA0400X
NJ44SC057384001041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)