Provider Demographics
NPI:1245551373
Name:MCKNIGHT, DEBRA M
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:MCKEOWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39820 US HIGHWAY 19 N LOT 18
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-8347
Mailing Address - Country:US
Mailing Address - Phone:585-520-5689
Mailing Address - Fax:
Practice Address - Street 1:4800 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5609
Practice Address - Country:US
Practice Address - Phone:727-847-0069
Practice Address - Fax:727-849-3780
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 137051041C0700X
NY0801681041C0700X
NY078515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker