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General NPI Number Information
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NPI Number | 1497804553
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Entity Type | Individual
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Provider Name | DAVID RICHARD JOHNSON M.S., MSAOM, L.AC.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 1156 E RIDGEWOOD AVE SUITE 4
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3935
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Country | US
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Telephone | 201-670-8443
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Fax | 201-612-7654
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Provider Business Mailing Address
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Address Line | 63 SUMMIT AVE
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City | WALDWICK
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State | NJ
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Zip | 07463-1915
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Country | US
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Telephone | 201-670-8443
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Fax | 201-612-7654
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SW05189900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 44SW05189900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SW05189900
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00053200
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License Number State | NJ
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