Healthcare Provider Details

I. General information

NPI: 1316439045
Provider Name (Legal Business Name): MIRRIAM KNIGHT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9022 COLUMBIA AVE
CLEVELAND OH
44108-2904
US

IV. Provider business mailing address

9022 COLUMBIA AVE
CLEVELAND OH
44108-2904
US

V. Phone/Fax

Practice location:
  • Phone: 216-372-6812
  • Fax:
Mailing address:
  • Phone: 216-372-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08308
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: