Provider Demographics
NPI:1467761288
Name:KNIGHT, SUSAN ALICIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ALICIA
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 MT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-7135
Mailing Address - Country:US
Mailing Address - Phone:845-344-2292
Mailing Address - Fax:845-342-2054
Practice Address - Street 1:379 MT HOPE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7135
Practice Address - Country:US
Practice Address - Phone:845-344-2292
Practice Address - Fax:845-342-2054
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1378441041S0200X
NY080217-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool