Provider Demographics
NPI:1003393893
Name:JOHNSON, JUSTINE (LPC)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:LABRUTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08829-1803
Mailing Address - Country:US
Mailing Address - Phone:908-377-3908
Mailing Address - Fax:
Practice Address - Street 1:6 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1319
Practice Address - Country:US
Practice Address - Phone:908-782-7905
Practice Address - Fax:908-782-5934
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00635000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional