Provider Demographics
NPI:1093117145
Name:JOHANSON, DONNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-1200
Mailing Address - Country:US
Mailing Address - Phone:860-350-2348
Mailing Address - Fax:860-350-2348
Practice Address - Street 1:40 SPRING LAKE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:CT
Practice Address - Zip Code:06784-1200
Practice Address - Country:US
Practice Address - Phone:860-350-2348
Practice Address - Fax:860-350-2348
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0083531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical