Healthcare Provider Details

I. General information

NPI: 1154442002
Provider Name (Legal Business Name): SHARON JAYNE JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E AND WEST RD
WEST SENECA NY
14224-3604
US

IV. Provider business mailing address

16885 JACKSON RD
HOLLEY NY
14470-9734
US

V. Phone/Fax

Practice location:
  • Phone: 716-517-3853
  • Fax:
Mailing address:
  • Phone: 585-638-5489
  • Fax: 585-589-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0351381
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: