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General NPI Number Information
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NPI Number | 1679896120
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Entity Type | Individual
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Provider Name | BRENDA BAMBINO KNIERIM LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 233A MERCHANTS CIR STE 100
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City | HAMPSTEAD
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State | NC
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Zip | 28443-5419
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Country | US
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Telephone | 910-297-7720
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Fax | 883-643-0176
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Provider Business Mailing Address
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Address Line | 108 CIRCLE DR
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City | HAMPSTEAD
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State | NC
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Zip | 28443-2108
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Country | US
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Telephone | 910-297-7720
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Fax | 833-643-0176
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006712
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License Number State | NC
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