Healthcare Provider Details

I. General information

NPI: 1982998985
Provider Name (Legal Business Name): HELEN JOHNSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 VINE ST APT 6C
LIVERPOOL NY
13088-5239
US

IV. Provider business mailing address

10 N MAIN ST
CORTLAND NY
13045-2130
US

V. Phone/Fax

Practice location:
  • Phone: 315-256-2696
  • Fax:
Mailing address:
  • Phone: 607-753-0234
  • Fax: 607-753-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: