Provider Demographics
NPI:1659963957
Name:KNOWLES, KAITLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAITLEN
Middle Name:
Last Name:KNOWLES
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 1:920 WINTON RD S STE 204
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1634
Mailing Address - Country:US
Mailing Address - Phone:585-734-8713
Mailing Address - Fax:
Practice Address - Street 1:3300 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3741
Practice Address - Country:US
Practice Address - Phone:585-281-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0878211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical