Healthcare Provider Details

I. General information

NPI: 1518536721
Provider Name (Legal Business Name): BIANCA CARRERO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN ST
DURHAM CT
06422-1653
US

IV. Provider business mailing address

212 MAIDEN LN
DURHAM CT
06422-2017
US

V. Phone/Fax

Practice location:
  • Phone: 860-245-9899
  • Fax:
Mailing address:
  • Phone: 860-245-9899
  • Fax: 860-362-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9201
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: