Healthcare Provider Details

I. General information

NPI: 1518564236
Provider Name (Legal Business Name): JACOB BIANCARDI LMHC, CSAYC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9111 BROADWAY STE O
MERRILLVILLE IN
46410-7002
US

IV. Provider business mailing address

1933 FERNDALE DR
DYER IN
46311-1892
US

V. Phone/Fax

Practice location:
  • Phone: 219-775-2241
  • Fax:
Mailing address:
  • Phone: 219-775-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number39003992A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: