Healthcare Provider Details

I. General information

NPI: 1023962131
Provider Name (Legal Business Name): TENESHA A JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JERICHO TPKE STE 212
FLORAL PARK NY
11001-2019
US

IV. Provider business mailing address

83 E FAIRVIEW AVE
VALLEY STREAM NY
11580-5927
US

V. Phone/Fax

Practice location:
  • Phone: 929-459-2844
  • Fax:
Mailing address:
  • Phone: 516-205-1654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number089678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: