Provider Demographics
NPI:1881765683
Name:KNOOP, JUDITH ALICE (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ALICE
Last Name:KNOOP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 LOCUST ST 3RD FL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5400
Mailing Address - Country:US
Mailing Address - Phone:215-985-4448
Mailing Address - Fax:215-985-4952
Practice Address - Street 1:1211 CHESTNUT ST STE 605
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4117
Practice Address - Country:US
Practice Address - Phone:215-525-8657
Practice Address - Fax:215-988-9062
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0127821041C0700X
AZLCSW-125861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035172530001Medicaid