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NPI Code Detail

MEDICARE: MISS CONNCETTA B JOHNSON SOCIAL WORKER LMSW

MEDICARE:  MISS CONNCETTA B JOHNSON  SOCIAL WORKER LMSW
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
1104100000XSocial Worker048788-1NY

General Provider Information

NPI Number : 1871747014
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CONNCETTA B JOHNSON SOCIAL WORKER LMSW
Provider Business Mailing Address
First Line : 1212 OGDEN AVE
Second Line :
City : BRONX
State : NY
Zip : 10452-3541
Country : US
Telephone Number : 646-391-4544
Fax Number : 718-299-7801
Provider Business Practice Location Address
First Line : 1212 OGDEN AVE # 2
Second Line :
City : BRONX
State : NY
Zip : 10452-3541
Country : US
Telephone Number : 646-391-4544
Fax Number : 718-299-7801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2008
Last Update Date : 11/14/2008

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Directions to “ MISS CONNCETTA B JOHNSON SOCIAL WORKER LMSW” Practice Location

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