Provider Demographics
NPI:1033443635
Name:JOHNSON, CHERYL E (LBSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4609
Mailing Address - Country:US
Mailing Address - Phone:505-566-3859
Mailing Address - Fax:505-566-3826
Practice Address - Street 1:3539 E 30TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8801
Practice Address - Country:US
Practice Address - Phone:505-566-3859
Practice Address - Fax:505-566-3826
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-05517104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker