Provider Demographics
NPI:1679672240
Name:KNOX, F. ROBERT (LISW)
Entity Type:Individual
Prefix:
First Name:F.
Middle Name:ROBERT
Last Name:KNOX
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2867
Mailing Address - Country:US
Mailing Address - Phone:505-268-6803
Mailing Address - Fax:505-268-8817
Practice Address - Street 1:2920 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 124
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2867
Practice Address - Country:US
Practice Address - Phone:505-268-6803
Practice Address - Fax:505-268-8817
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-00981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90231Medicaid