Healthcare Provider Details

I. General information

NPI: 1487473187
Provider Name (Legal Business Name): BIANCA DAGUANNO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CEDAR AVE
FARMINGDALE NY
11735-3802
US

IV. Provider business mailing address

45 CEDAR AVE
FARMINGDALE NY
11735-3802
US

V. Phone/Fax

Practice location:
  • Phone: 516-509-8849
  • Fax:
Mailing address:
  • Phone: 516-509-8849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: