Provider Demographics
NPI:1922351196
Name:KNORR, PAIGE LEIGH
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:LEIGH
Last Name:KNORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 COUNTRY GOLF DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8345
Mailing Address - Country:US
Mailing Address - Phone:239-961-8410
Mailing Address - Fax:
Practice Address - Street 1:2404 COUNTRY GOLF DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8345
Practice Address - Country:US
Practice Address - Phone:239-961-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist