MEDICARE: CRAIG W. KNAPP PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	261	VT

General Provider Information

NPI Number	:	1104972959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG W. KNAPP PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:	646 N. SHREWSBURY ROAD
City	:	N CLARENDON
State	:	VT
Zip	:	05759-0218
Country	:	US
Telephone Number	:	802-775-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	646 N. SHREWSBURY ROAD
Second Line	:
City	:	N CLARENDON
State	:	VT
Zip	:	05759-0218
Country	:	US
Telephone Number	:	802-775-2728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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