Provider Demographics
NPI:1497113328
Name:MCKNIGHT, J A (LCSW)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:A
Last Name:MCKNIGHT
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 1:4094 TICHENOR RD
Mailing Address - Street 2:
Mailing Address - City:HECTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14841-9638
Mailing Address - Country:US
Mailing Address - Phone:415-359-7831
Mailing Address - Fax:833-211-1460
Practice Address - Street 1:4094 TICHENOR RD
Practice Address - Street 2:
Practice Address - City:HECTOR
Practice Address - State:NY
Practice Address - Zip Code:14841-9638
Practice Address - Country:US
Practice Address - Phone:415-359-7831
Practice Address - Fax:833-211-1460
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-06
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0839931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical