Provider Demographics
NPI:1235149121
Name:KNOLL, ANN E (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:E
Last Name:KNOLL
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:E
Other - Last Name:D'AGOSTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:31 THURBER DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1600
Mailing Address - Country:US
Mailing Address - Phone:315-539-1980
Mailing Address - Fax:315-539-1054
Practice Address - Street 1:31 THURBER DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1600
Practice Address - Country:US
Practice Address - Phone:315-539-1980
Practice Address - Fax:315-539-1054
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002647Medicaid