Provider Demographics
NPI:1972801835
Name:MCKNIGHT, ERIC YOUNGBLOOD WILLIE (LICSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:YOUNGBLOOD WILLIE
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CHESTNUT ST
Mailing Address - Street 2:FLOOR 5
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4645
Mailing Address - Country:US
Mailing Address - Phone:401-465-0156
Mailing Address - Fax:401-415-0325
Practice Address - Street 1:150 CHESTNUT ST
Practice Address - Street 2:FLOOR 5
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4645
Practice Address - Country:US
Practice Address - Phone:401-465-0156
Practice Address - Fax:401-415-0325
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW021351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIISW02135OtherPROFESSIONAL LICENSE