Provider Demographics
NPI:1659601276
Name:ROMANO KNECHT, GINA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:ROMANO KNECHT
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 1:2568 PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3739
Mailing Address - Country:US
Mailing Address - Phone:516-435-7328
Mailing Address - Fax:
Practice Address - Street 1:1918 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5641
Practice Address - Country:US
Practice Address - Phone:516-435-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080381-1104100000X
NY080924-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker