Provider Demographics
NPI:1093325276
Name:BERMUDEZ, NIDIA M (MSW, LCSWA)
Entity Type:Individual
Prefix:MISS
First Name:NIDIA
Middle Name:M
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S NEW HOPE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4825
Mailing Address - Country:US
Mailing Address - Phone:704-208-1865
Mailing Address - Fax:704-208-1865
Practice Address - Street 1:609 S NEW HOPE RD STE 102
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4825
Practice Address - Country:US
Practice Address - Phone:704-208-1865
Practice Address - Fax:704-208-1865
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0145591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty