Provider Demographics
NPI:1538231709
Name:KNAPP, ELLEN G (LICSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:G
Last Name:KNAPP
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2253
Mailing Address - Country:US
Mailing Address - Phone:802-442-8164
Mailing Address - Fax:802-442-4214
Practice Address - Street 1:339 DEWEY ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2253
Practice Address - Country:US
Practice Address - Phone:802-442-8164
Practice Address - Fax:802-442-4214
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00001261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
615532OtherMVP
VT0VN2571Medicaid
VTVN2571Medicare ID - Type Unspecified