Provider Demographics
NPI:1184008518
Name:JOHNSON, JUANITA LITISHA (LCSW)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:LITISHA
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 1:11 LAWRENCE ST
Mailing Address - Street 2:UNIT 603
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 LAWRENCE ST
Practice Address - Street 2:UNIT 603
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1431
Practice Address - Country:US
Practice Address - Phone:251-243-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220799104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker