Healthcare Provider Details

I. General information

NPI: 1467401919
Provider Name (Legal Business Name): TIM STUART KNAPPENBERGER ACSW, LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CLEVELAND AVE NW SUITE 300
CANTON OH
44702-1700
US

IV. Provider business mailing address

6237 PALMER DR NW
CANTON OH
44718-1053
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-7066
  • Fax:
Mailing address:
  • Phone: 330-499-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0000495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: