=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972279271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHEY DOMINIQUE JOHNSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2021
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 GLENBROOK RD STE 3
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-693-4917
-----------------------------------------------------
Fax | 203-802-6271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 88 MERRELL AVE
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-3649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 475-350-3916
-----------------------------------------------------
Fax | 475-350-3917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------