Provider Demographics
NPI:1154465599
Name:KNOWLES, MARTIN J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SHALE DR
Mailing Address - Street 2:
Mailing Address - City:BEARSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12409-5713
Mailing Address - Country:US
Mailing Address - Phone:845-616-1512
Mailing Address - Fax:
Practice Address - Street 1:101 HURLEY AVE STE 4
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2836
Practice Address - Country:US
Practice Address - Phone:845-430-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical