Healthcare Provider Details

I. General information

NPI: 1063339711
Provider Name (Legal Business Name): STEVE JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NEW PARK AVE
WEST HARTFORD CT
06110-1142
US

IV. Provider business mailing address

93 ELAM ST
NEW BRITAIN CT
06053-2705
US

V. Phone/Fax

Practice location:
  • Phone: 860-578-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: