Provider Demographics
NPI:1801641725
Name:NICCOLAI, BIANCA MORAY
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:MORAY
Last Name:NICCOLAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SHIDLER RUN RD
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:PA
Mailing Address - Zip Code:15311-1228
Mailing Address - Country:US
Mailing Address - Phone:724-809-4483
Mailing Address - Fax:
Practice Address - Street 1:640 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4119
Practice Address - Country:US
Practice Address - Phone:724-222-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health