Provider Demographics
NPI:1720465453
Name:GEORGESCU, BIANCA (PSYD)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:GEORGESCU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ALEXANDRA DR
Mailing Address - Street 2:3112
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6023
Mailing Address - Country:US
Mailing Address - Phone:201-736-5515
Mailing Address - Fax:
Practice Address - Street 1:2801 ALEXANDRA DR
Practice Address - Street 2:3112
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6023
Practice Address - Country:US
Practice Address - Phone:201-736-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26833103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist