MEDICARE: AMY RAE JOHNSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC06360000	NJ

General Provider Information

NPI Number	:	1053140889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY RAE JOHNSON LCSW

Provider Business Mailing Address
First Line	:	226 16TH AVE
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-1770
Country	:	US
Telephone Number	:	520-250-5999
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 16TH AVE
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-1770
Country	:	US
Telephone Number	:	802-465-3737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2024
Last Update Date	:	01/07/2026

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