Provider Demographics
NPI:1528223138
Name:KNUPP, JASON (LMSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KNUPP
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14014 ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9301
Mailing Address - Country:US
Mailing Address - Phone:585-589-7066
Mailing Address - Fax:585-589-6395
Practice Address - Street 1:14014 ROUTE 31
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9301
Practice Address - Country:US
Practice Address - Phone:585-589-7066
Practice Address - Fax:585-589-6395
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074852-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00648559Medicaid