Healthcare Provider Details

I. General information

NPI: 1083051411
Provider Name (Legal Business Name): PAMELA JEAN JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N US HIGHWAY 1 APT 661
JUPITER FL
33477-4445
US

IV. Provider business mailing address

1000 N US HIGHWAY 1 APT 661
JUPITER FL
33477-4445
US

V. Phone/Fax

Practice location:
  • Phone: 561-308-8876
  • Fax:
Mailing address:
  • Phone: 561-308-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: