Provider Demographics
NPI:1124362009
Name:JOHNSON, RAI TAYLOR (BSW)
Entity Type:Individual
Prefix:
First Name:RAI
Middle Name:TAYLOR
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 NW 2ND AVE., SUITE #1
Mailing Address - Street 2:THE SUNDARI FOUNDATION, INC.
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-438-0556
Mailing Address - Fax:305-438-0557
Practice Address - Street 1:1514 NW 2ND AVE., SUITE #1
Practice Address - Street 2:THE SUNDARI FOUNDATION, INC.
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-438-0556
Practice Address - Fax:305-438-0557
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL810652266OtherCOMMERCIAL