Healthcare Provider Details

I. General information

NPI: 1881521961
Provider Name (Legal Business Name): ISAAC THOMAS JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PLEASANT AVE APT 1
SUFFERN NY
10901-4631
US

IV. Provider business mailing address

5 PLEASANT AVE APT 1
SUFFERN NY
10901-4631
US

V. Phone/Fax

Practice location:
  • Phone: 785-424-2448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2026202261
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number127217
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07394300
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number01906797
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: