Provider Demographics
NPI:1144998956
Name:PASSACANTILLI, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:PASSACANTILLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2620
Mailing Address - Country:US
Mailing Address - Phone:781-258-5466
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 246F
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6506
Practice Address - Country:US
Practice Address - Phone:781-269-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health