Healthcare Provider Details

I. General information

NPI: 1124451836
Provider Name (Legal Business Name): ANGELA BIANCO ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 07/21/2022
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 MORENA BLVD STE 100
SAN DIEGO CA
92110-3850
US

IV. Provider business mailing address

1260 MORENA BLVD STE 100
SAN DIEGO CA
92110-3850
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-0355
  • Fax:
Mailing address:
  • Phone: 619-398-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW67892
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number93994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: