Provider Demographics
NPI:1851350268
Name:KNIERIEM, CAROL (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:KNIERIEM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 ELM ST
Mailing Address - Street 2:PASTORAL COUNSELING SERVICES
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2528
Mailing Address - Country:US
Mailing Address - Phone:603-627-2702
Mailing Address - Fax:603-627-3643
Practice Address - Street 1:2013 ELM ST
Practice Address - Street 2:PASTORAL COUNSELING SERVICES
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2528
Practice Address - Country:US
Practice Address - Phone:603-627-2702
Practice Address - Fax:603-627-3643
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30421027Medicaid
NH387284OtherMVP PIN
NH1401353Y0NH01OtherANTHEM ACES #
P00014340OtherRR MEDICARE
NH100821OtherCIGNA BH PIN
NH387284OtherMVP PIN
NHRE1615Medicare PIN