Provider Demographics
NPI:1871271536
Name:BRENDIBLE, DANIEL NERMO (LCSW, CDC1, BHC1)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:NERMO
Last Name:BRENDIBLE
Suffix:
Gender:M
Credentials:LCSW, CDC1, BHC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:METLAKATLA
Mailing Address - State:AK
Mailing Address - Zip Code:99926-0726
Mailing Address - Country:US
Mailing Address - Phone:907-617-3146
Mailing Address - Fax:
Practice Address - Street 1:563 BRENDIBLE STREET
Practice Address - Street 2:
Practice Address - City:METLAKATLA
Practice Address - State:AK
Practice Address - Zip Code:99926
Practice Address - Country:US
Practice Address - Phone:907-886-7491
Practice Address - Fax:907-886-4357
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2077411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical