Provider Demographics
NPI:1427683762
Name:BIASE, VIRGINIA CAROLINE
Entity type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:CAROLINE
Last Name:BIASE
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:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:ISLAND HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08732-1079
Mailing Address - Country:US
Mailing Address - Phone:252-646-8933
Mailing Address - Fax:
Practice Address - Street 1:192 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ISLAND HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08732-0873
Practice Address - Country:US
Practice Address - Phone:252-646-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1151689101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
00092396300OtherMILITARY ID