Healthcare Provider Details

I. General information

NPI: 1538505573
Provider Name (Legal Business Name): DEBORAH SUE BIANCHI LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 US ROUTE 5
DERBY VT
05829-9677
US

IV. Provider business mailing address

140 VALENTINE AVE
DERBY LINE VT
05830-8742
US

V. Phone/Fax

Practice location:
  • Phone: 802-323-4677
  • Fax: 802-766-2620
Mailing address:
  • Phone: 802-323-4677
  • Fax: 802-766-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000587
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: