Provider Demographics
NPI:1871075747
Name:KNIGHT, KELLEY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GULF RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01002-9763
Mailing Address - Country:US
Mailing Address - Phone:413-253-2878
Mailing Address - Fax:
Practice Address - Street 1:212 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3583
Practice Address - Country:US
Practice Address - Phone:413-587-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1102961041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty