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General NPI Number Information
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NPI Number | 1720236219
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Entity Type | Individual
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Provider Name | DERWIN JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 380 NASSAU RD
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City | ROOSEVELT
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State | NY
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Zip | 11575-1343
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Country | US
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Telephone | 516-623-7741
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Fax | 516-623-7775
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Provider Business Mailing Address
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Address Line | 10 IRVING PL
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City | ROOSEVELT
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State | NY
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Zip | 11575-2224
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Country | US
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Telephone | 516-208-8454
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 19272
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License Number State | NY
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