Provider Demographics
NPI:1063036861
Name:BISSELL, JOHANNA (MSW)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:BISSELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2914
Mailing Address - Country:US
Mailing Address - Phone:631-707-4945
Mailing Address - Fax:631-618-3217
Practice Address - Street 1:131 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9098
Practice Address - Country:US
Practice Address - Phone:516-297-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker