Provider Demographics
NPI:1073668372
Name:JOHANNESSON, CHRISTINE M (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:JOHANNESSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:JOHANNESSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3415
Mailing Address - Country:US
Mailing Address - Phone:610-279-9270
Mailing Address - Fax:610-279-4146
Practice Address - Street 1:1201 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3415
Practice Address - Country:US
Practice Address - Phone:610-279-9270
Practice Address - Fax:610-279-4146
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1242791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical