Provider Demographics
NPI:1184866824
Name:DREW M. JOHNSON LCSW LLC
Entity Type:Organization
Organization Name:DREW M. JOHNSON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:MCNEILL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:917-568-7524
Mailing Address - Street 1:94 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1810
Mailing Address - Country:US
Mailing Address - Phone:917-568-7524
Mailing Address - Fax:973-763-8243
Practice Address - Street 1:2130 MILLBURN AVE STE D1
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3749
Practice Address - Country:US
Practice Address - Phone:973-763-8123
Practice Address - Fax:973-763-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05288400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122985Medicare PIN
NJ147838Medicare PIN