Provider Demographics
NPI:1033202213
Name:JOHNSTON, CATHERINE A (LCSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:A
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-1218
Mailing Address - Country:US
Mailing Address - Phone:260-456-4880
Mailing Address - Fax:260-456-3559
Practice Address - Street 1:2805 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:FT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:47807
Practice Address - Country:US
Practice Address - Phone:260-456-4880
Practice Address - Fax:260-456-3559
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB28086Medicare UPIN
IN137100GMedicare PIN
IN137100BMedicare PIN