Healthcare Provider Details

I. General information

NPI: 1386803625
Provider Name (Legal Business Name): BROOKLYN R KNEIP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N GREEN VALLEY PKWY BLDG 3 SUITE 312
HENDERSON NV
89014-0406
US

IV. Provider business mailing address

2920 N GREEN VALLEY PKWY BLDG 3 SUITE 312
HENDERSON NV
89014-0406
US

V. Phone/Fax

Practice location:
  • Phone: 702-253-1173
  • Fax: 702-253-1468
Mailing address:
  • Phone: 702-253-1173
  • Fax: 702-253-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5250-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: