Healthcare Provider Details

I. General information

NPI: 1265369250
Provider Name (Legal Business Name): ZELMON MARIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DWIGHT RD
LONGMEADOW MA
01106-1765
US

IV. Provider business mailing address

21 DWIGHT RD
LONGMEADOW MA
01106-1765
US

V. Phone/Fax

Practice location:
  • Phone: 413-795-4762
  • Fax: 413-795-8502
Mailing address:
  • Phone: 413-795-4762
  • Fax: 413-795-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW226876
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: