Provider Demographics
NPI:1770101602
Name:KNECHT, DEBORAH M
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:M
Last Name:KNECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:MARIA
Other - Last Name:KNECHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, LBS, CGCS
Mailing Address - Street 1:466 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2167
Mailing Address - Country:US
Mailing Address - Phone:570-299-0092
Mailing Address - Fax:
Practice Address - Street 1:466 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-2167
Practice Address - Country:US
Practice Address - Phone:570-299-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH000465OtherLICENSED BEHAVIOR SPECIALIST