Healthcare Provider Details

I. General information

NPI: 1801985866
Provider Name (Legal Business Name): BIANCA E. GOLONDRINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BIANCA DE ANDA LCSW

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12330 FAIRLAWN DR
RIVERVIEW FL
33579-3906
US

IV. Provider business mailing address

12330 FAIRLAWN DR
RIVERVIEW FL
33579-3906
US

V. Phone/Fax

Practice location:
  • Phone: 310-463-8115
  • Fax:
Mailing address:
  • Phone: 310-463-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number80366
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number80366
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number80366
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number80366
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: