Healthcare Provider Details

I. General information

NPI: 1083280127
Provider Name (Legal Business Name): BIANCA CARTER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 05/30/2021
Certification Date: 05/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 REGENCY DR STE 102
BLOOMFIELD CT
06002-2310
US

IV. Provider business mailing address

955 MIX AVE APT 1J
HAMDEN CT
06514-5126
US

V. Phone/Fax

Practice location:
  • Phone: 860-375-5749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5207
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: