Provider Demographics
NPI:1225370034
Name:KNICOS, FERN H
Entity Type:Individual
Prefix:
First Name:FERN
Middle Name:H
Last Name:KNICOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 S CYPRESS BEND DR
Mailing Address - Street 2:APT. 207
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5639
Mailing Address - Country:US
Mailing Address - Phone:954-970-3963
Mailing Address - Fax:
Practice Address - Street 1:2209 S CYPRESS BEND DR
Practice Address - Street 2:APT. 207
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5639
Practice Address - Country:US
Practice Address - Phone:954-970-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker