Healthcare Provider Details

I. General information

NPI: 1144891615
Provider Name (Legal Business Name): KATTYA CORAL-BIANCULLI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 NASSAU ST
PRINCETON NJ
08540-4623
US

IV. Provider business mailing address

9 BROWN PL
ABERDEEN NJ
07747-1002
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-0060
  • Fax:
Mailing address:
  • Phone: 973-767-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05996600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: