Healthcare Provider Details

I. General information

NPI: 1588375323
Provider Name (Legal Business Name): SUMMER JOHNSON LICSW CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BIRCH ST STE A6
MILFORD MA
01757-3585
US

IV. Provider business mailing address

400 N DUPONT HWY APT D36
DOVER DE
19901-2579
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-0999
  • Fax:
Mailing address:
  • Phone: 603-498-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2055
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1140295
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012159
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: