Healthcare Provider Details

I. General information

NPI: 1861911414
Provider Name (Legal Business Name): TARRA DOWNEY JOHNSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ADAM CLAYTON POWELL JR BLVD FL 4
NEW YORK NY
10027-4941
US

IV. Provider business mailing address

273 HULL ST APT 3
BROOKLYN NY
11233-2906
US

V. Phone/Fax

Practice location:
  • Phone: 212-553-6708
  • Fax: 212-222-1683
Mailing address:
  • Phone: 617-460-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099862
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: