MEDICARE: MS. BROOKE DUNNE JOHNSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	080557	NY

General Provider Information

NPI Number	:	1528286531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BROOKE DUNNE JOHNSON LCSW

Provider Business Mailing Address
First Line	:	153 VALLEY RD
Second Line	:
City	:	KATONAH
State	:	NY
Zip	:	10536-1714
Country	:	US
Telephone Number	:	914-523-6687
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 GRAMATAN AVE
Second Line	:	C/O WJCS, SUITE 401
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-3208
Country	:	US
Telephone Number	:	914-668-8938
Fax Number	:	914-668-2545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	02/20/2015

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