Individual
BRUNO ANTHONY NIEMITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LMFT
Contact information
Practice address
3937 WESTERN BLVD, RALEIGH, NC 27606-1936
(919) 821-0790
(919) 861-8961
Mailing address
PO BOX 33393, RALEIGH, NC 27636-3393
(919) 821-0790
(919) 861-8961
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C000064
NC
106H00000X
Marriage & Family Therapist
487
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6003333
—
NC
01
—
62601
BCBS PROVIDER NUMBER
NC
Enumeration date
11/01/2006
Last updated
07/20/2009
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