Provider Demographics
NPI:1811753544
Name:KNECHT, OLIVIA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:KNECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-9219
Mailing Address - Country:US
Mailing Address - Phone:585-233-2817
Mailing Address - Fax:833-411-5741
Practice Address - Street 1:374 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-9219
Practice Address - Country:US
Practice Address - Phone:585-233-2817
Practice Address - Fax:833-411-5741
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0240601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical