Provider Demographics
NPI:1124196027
Name:JOHNSON, LAURA KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:JOHNSON
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 1:28 EGYPT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217-5104
Mailing Address - Country:US
Mailing Address - Phone:207-875-2800
Mailing Address - Fax:
Practice Address - Street 1:143 POTTLE RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-3362
Practice Address - Country:US
Practice Address - Phone:207-743-8221
Practice Address - Fax:207-743-7913
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC88431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical