Provider Demographics
NPI:1245020031
Name:SQUIRES, BIANNCA (LPC)
Entity type:Individual
Prefix:
First Name:BIANNCA
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COMMODORE HULL DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2255
Mailing Address - Country:US
Mailing Address - Phone:203-906-9913
Mailing Address - Fax:
Practice Address - Street 1:12 COMMODORE HULL DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2255
Practice Address - Country:US
Practice Address - Phone:203-906-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health