Healthcare Provider Details

I. General information

NPI: 1811753544
Provider Name (Legal Business Name): OLIVIA KNECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MOUNTAIN BLVD
WERNERSVILLE PA
19565-9219
US

IV. Provider business mailing address

374 MOUNTAIN BLVD
WERNERSVILLE PA
19565-9219
US

V. Phone/Fax

Practice location:
  • Phone: 585-233-2817
  • Fax: 833-411-5741
Mailing address:
  • Phone: 585-233-2817
  • Fax: 833-411-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024060
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: