Doctor Name: | JACQUELINE JOHNSON |
NPI Number: | 1003177577 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 078459 |
Business Practice Address: | 633 Gidney Ave Suite 6 Newburgh, NY - 125502800 |
Business Phone Number: | 8455692900 |
Business Fax Number: | 8666195710 |
Mailing Address: | 633 Gidney Ave, Suite 6 NEWBURGH |
State: | NY |
Postal Code: | 125502800 |
Phone Number: | 8455692900 |
Fax Number: | 8666195710 |
NPI Enumeration Date: | 05/31/2012 |
NPI Last Update Date: | 05/31/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 078459 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |