Healthcare Provider Details

I. General information

NPI: 1043349780
Provider Name (Legal Business Name): RORI A KNOTT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FRANKLIN ST SUITE 2A
BANGOR ME
04401
US

IV. Provider business mailing address

115 FRANKLIN ST SUITE 2A
BANGOR ME
04401
US

V. Phone/Fax

Practice location:
  • Phone: 207-745-3142
  • Fax: 207-973-6109
Mailing address:
  • Phone: 207-745-3142
  • Fax: 207-973-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL2564
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: