Healthcare Provider Details

I. General information

NPI: 1467674168
Provider Name (Legal Business Name): DEIRDRE DEANNE JOHNSON BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WOODLAND ST 51 CAPEN ST HARTFORD CT 06120
HARTFORD CT
06105-1233
US

IV. Provider business mailing address

103 WOODLAND ST
HARTFORD CT
06105-1233
US

V. Phone/Fax

Practice location:
  • Phone: 860-241-0317
  • Fax: 860-241-0327
Mailing address:
  • Phone: 860-241-0317
  • Fax: 860-241-0327

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: