Provider Demographics
NPI:1801952460
Name:KNIGHT, PENELOPE S (LISW AND ACSW)
Entity type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:S
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LISW AND ACSW
Other - Prefix:MS
Other - First Name:PENELOPE
Other - Middle Name:C
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW AND ACSW
Mailing Address - Street 1:4405 MONTAGANO BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3544
Mailing Address - Country:US
Mailing Address - Phone:216-291-0681
Mailing Address - Fax:216-291-0681
Practice Address - Street 1:25901 EMERY RD
Practice Address - Street 2:#108
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5774
Practice Address - Country:US
Practice Address - Phone:440-429-3027
Practice Address - Fax:216-291-0681
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00060301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKNSW06351Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID NO