Provider Demographics
NPI:1235387077
Name:KNORR, TINA M
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:KNORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:KASSHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 BROAD ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1590
Mailing Address - Country:US
Mailing Address - Phone:570-421-7868
Mailing Address - Fax:570-421-7820
Practice Address - Street 1:134 BROAD ST
Practice Address - Street 2:SUITE 7
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1590
Practice Address - Country:US
Practice Address - Phone:570-421-7868
Practice Address - Fax:570-421-7820
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7318-1231041C0700X
PACW0171311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39399300Medicaid