Healthcare Provider Details

I. General information

NPI: 1083154942
Provider Name (Legal Business Name): MANOUCHEKA JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 KINGS HWY N STE 250
CHERRY HILL NJ
08034-1910
US

IV. Provider business mailing address

1060 KINGS HWY N STE 250
CHERRY HILL NJ
08034-1910
US

V. Phone/Fax

Practice location:
  • Phone: 856-486-5853
  • Fax:
Mailing address:
  • Phone: 856-486-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05777500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: