Healthcare Provider Details

I. General information

NPI: 1740202274
Provider Name (Legal Business Name): DEBORAH J JOHNSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 NORTH MAIN STREET
DAYVILLE CT
06241
US

IV. Provider business mailing address

503 PLEASANT ST # 2
WILLIMANTIC CT
06226-3221
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-4480
  • Fax:
Mailing address:
  • Phone: 860-423-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: