Provider Demographics
NPI:1114011574
Name:BIANCHINA, MARY JO (MA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:BIANCHINA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JO
Other - Last Name:BIANCHINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:115 W 8TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2997
Mailing Address - Country:US
Mailing Address - Phone:541-505-8168
Mailing Address - Fax:
Practice Address - Street 1:115 W 8TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2997
Practice Address - Country:US
Practice Address - Phone:541-505-8168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR10237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist