Healthcare Provider Details

I. General information

NPI: 1295358364
Provider Name (Legal Business Name): BRENDAN JOSEPH NIERENBERG LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRENDAN JOSEPH NIERENBERG LMFT

II. Dates (important events)

Enumeration Date: 05/24/2020
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date: 11/26/2020
Reactivation Date: 01/20/2021

III. Provider practice location address

9713 SANTA MONICA BLVD STE 207
BEVERLY HILLS CA
90210-4243
US

IV. Provider business mailing address

1461 BUSTER ST
SIMI VALLEY CA
93065-3217
US

V. Phone/Fax

Practice location:
  • Phone: 833-624-5400
  • Fax:
Mailing address:
  • Phone: 818-620-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number118762
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number118762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: