Provider Demographics
NPI:1760189922
Name:KNOWLES, JEREMIAH ISAIAH (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:ISAIAH
Last Name:KNOWLES
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 1:48 BUCKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1406
Mailing Address - Country:US
Mailing Address - Phone:607-654-9056
Mailing Address - Fax:
Practice Address - Street 1:20 ARCAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3630
Practice Address - Country:US
Practice Address - Phone:585-225-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical