Provider Demographics
NPI:1073791083
Name:JOHNSEN, STEVEN CHRISTOPHER
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CHRISTOPHER
Last Name:JOHNSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CASTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3004
Mailing Address - Country:US
Mailing Address - Phone:718-568-4011
Mailing Address - Fax:
Practice Address - Street 1:170 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3004
Practice Address - Country:US
Practice Address - Phone:718-568-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical