Healthcare Provider Details

I. General information

NPI: 1790612968
Provider Name (Legal Business Name): GENEROSE EUPHRASIA JOHNSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WILSON PL FL 2
MOUNT VERNON NY
10550-2602
US

IV. Provider business mailing address

2 WILSON PL FL 2
MOUNT VERNON NY
10550-2602
US

V. Phone/Fax

Practice location:
  • Phone: 914-668-9124
  • Fax: 914-668-0940
Mailing address:
  • Phone: 914-668-9124
  • Fax: 914-668-0940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP131595
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: