Provider Demographics
NPI:1225759657
Name:JOHNSON, MICHELLE AMANDA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:AMANDA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-1637
Mailing Address - Country:US
Mailing Address - Phone:412-913-7062
Mailing Address - Fax:
Practice Address - Street 1:363 VANADIUM RD STE 105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1477
Practice Address - Country:US
Practice Address - Phone:412-368-2211
Practice Address - Fax:412-279-1418
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136658104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker