Provider Demographics
NPI:1063080240
Name:KNIGHT, CASEY-LYN IRIS (LMSW-CC)
Entity type:Individual
Prefix:
First Name:CASEY-LYN
Middle Name:IRIS
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4059
Mailing Address - Country:US
Mailing Address - Phone:207-689-7258
Mailing Address - Fax:
Practice Address - Street 1:GATEWAY COMMUNITY SERVICES
Practice Address - Street 2:124 CANAL ST SUITE B
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-536-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC197781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical