Healthcare Provider Details

I. General information

NPI: 1285739508
Provider Name (Legal Business Name): WILLIAM ANTHONY KNOTHE LCSW-4
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ALEXANDER ST
ROCHESTER NY
14607-4002
US

IV. Provider business mailing address

PO BOX 10787
ROCHESTER NY
14610-0787
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-7770
  • Fax: 585-922-1985
Mailing address:
  • Phone: 585-922-1122
  • Fax: 585-922-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075130
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number044588
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: