Healthcare Provider Details

I. General information

NPI: 1457056616
Provider Name (Legal Business Name): MEGAN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 HIGHLAND AVE STE B
CHESHIRE CT
06410-2531
US

IV. Provider business mailing address

74 WASHINGTON RD APT 6
WOODBURY CT
06798-2855
US

V. Phone/Fax

Practice location:
  • Phone: 203-599-1492
  • Fax:
Mailing address:
  • Phone: 518-926-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6579
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: