Provider Demographics
NPI:1396006086
Name:BENNERMAN, CARLOS GERMAINE (MSW, P-LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:GERMAINE
Last Name:BENNERMAN
Suffix:
Gender:M
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SE GREENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4512
Mailing Address - Country:US
Mailing Address - Phone:910-987-3831
Mailing Address - Fax:
Practice Address - Street 1:1002 SE GREENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4512
Practice Address - Country:US
Practice Address - Phone:910-987-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0072651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical