Provider Demographics
NPI:1679896120
Name:KNIERIM, BRENDA BAMBINO (LCSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:BAMBINO
Last Name:KNIERIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2108
Mailing Address - Country:US
Mailing Address - Phone:910-297-7720
Mailing Address - Fax:833-643-0176
Practice Address - Street 1:233A MERCHANTS CIR STE 100
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-5419
Practice Address - Country:US
Practice Address - Phone:910-297-7720
Practice Address - Fax:883-643-0176
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0067121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC006712OtherNC SOCIAL WORK LICENSURE BOARD