Healthcare Provider Details

I. General information

NPI: 1881765683
Provider Name (Legal Business Name): JUDITH ALICE KNOOP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 CHESTNUT ST STE 605
PHILADELPHIA PA
19107-4117
US

IV. Provider business mailing address

1233 LOCUST ST 3RD FL
PHILADELPHIA PA
19107-5400
US

V. Phone/Fax

Practice location:
  • Phone: 215-525-8657
  • Fax: 215-988-9062
Mailing address:
  • Phone: 215-985-4448
  • Fax: 215-985-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012782
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-12586
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: