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General NPI Number Information
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NPI Number | 1265895726
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Entity Type | Individual
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Provider Name | KATIE JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 18 ONECO STREET
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City | NORWICH
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State | CT
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Zip | 06360
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Country | US
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Telephone | 860-389-2591
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Fax |
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Provider Business Mailing Address
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Address Line | 270 BUCKLEY RD
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City | SALEM
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State | CT
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Zip | 06420-3713
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Country | US
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Telephone | 860-389-2591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 008983
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License Number State | CT
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