MEDICARE: MRS. KARANEQUA LATRICE BAGNERISE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	109080	TX
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1790145878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARANEQUA LATRICE BAGNERISE LCSW

Provider Business Mailing Address
First Line	:	2232 COTTONWOOD LN
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-5114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 COTTONWOOD LN
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-5114
Country	:	US
Telephone Number	:	619-368-3601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	01/12/2026

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