MEDICARE: FERN H KNICOS

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1225370034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERN H KNICOS

Provider Business Mailing Address
First Line	:	2209 S CYPRESS BEND DR
Second Line	:	APT. 207
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-5639
Country	:	US
Telephone Number	:	954-970-3963
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 S CYPRESS BEND DR
Second Line	:	APT. 207
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-5639
Country	:	US
Telephone Number	:	954-970-3963
Fax Number	:

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

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/19/2013

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