Healthcare Provider Details

I. General information

NPI: 1932748563
Provider Name (Legal Business Name): BRE-ANNA MICHELE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 WESTERN AVE STE 4
ALBANY NY
12203-3537
US

IV. Provider business mailing address

100 NEW BROADWAY APT 226
RENSSELAER NY
12144-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-308-8628
  • Fax: 518-900-1568
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: