Provider Demographics
NPI:1679276281
Name:LACRETE, BIANCA ANNABELL
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:ANNABELL
Last Name:LACRETE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 LINCOLN COURT AVE NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1826
Mailing Address - Country:US
Mailing Address - Phone:954-245-2098
Mailing Address - Fax:
Practice Address - Street 1:9244 CHELSEA DR S
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-6275
Practice Address - Country:US
Practice Address - Phone:470-632-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician