Provider Demographics
NPI:1609662493
Name:KNOLL, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KNOLL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BIMINI PL APT 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5900
Mailing Address - Country:US
Mailing Address - Phone:210-683-9712
Mailing Address - Fax:
Practice Address - Street 1:117 BIMINI PL APT 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5900
Practice Address - Country:US
Practice Address - Phone:210-683-9712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health