MEDICARE: ALISON PARDALIS JOHNSON

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	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1538709597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON PARDALIS JOHNSON

Provider Business Mailing Address
First Line	:	43 GILLOTTI RD
Second Line	:
City	:	NEW FAIRFIELD
State	:	CT
Zip	:	06812-2514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1781 COLD SPRING RD
Second Line	:
City	:	WILLIAMSTOWN
State	:	MA
Zip	:	01267-2770
Country	:	US
Telephone Number	:	443-744-9090
Fax Number	:

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

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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