Provider Demographics
NPI:1316439045
Name:KNIGHT, MIRRIAM (PSYD)
Entity type:Individual
Prefix:DR
First Name:MIRRIAM
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9022 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2904
Mailing Address - Country:US
Mailing Address - Phone:216-372-6812
Mailing Address - Fax:
Practice Address - Street 1:9022 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2904
Practice Address - Country:US
Practice Address - Phone:216-372-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OHP.08308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No251S00000XAgenciesCommunity/Behavioral Health