Provider Demographics
NPI:1568971984
Name:KNIGHTS, RODERIC R JR (LICSW)
Entity Type:Individual
Prefix:
First Name:RODERIC
Middle Name:R
Last Name:KNIGHTS
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 HALE ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9616
Mailing Address - Country:US
Mailing Address - Phone:802-356-5001
Mailing Address - Fax:
Practice Address - Street 1:40 LAKEMONT RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9459
Practice Address - Country:US
Practice Address - Phone:802-334-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01307761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1031537Medicaid