Provider Demographics
NPI:1477646545
Name:KNOBLER, KARL THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:THOMAS
Last Name:KNOBLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 LINCOLN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2018
Mailing Address - Country:US
Mailing Address - Phone:510-949-0945
Mailing Address - Fax:510-528-3539
Practice Address - Street 1:2046 LINCOLN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2018
Practice Address - Country:US
Practice Address - Phone:510-949-0945
Practice Address - Fax:510-528-3539
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6270103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL62700Medicare ID - Type Unspecified