Provider Demographics
NPI:1396507224
Name:KNIGHT, MARIO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MARIO KNIGHT, LMSW
Mailing Address - Street 1:2146 WATSON AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2146 WATSON AVE APT 1F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5557
Practice Address - Country:US
Practice Address - Phone:347-740-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09940301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker