Provider Demographics
NPI:1235459959
Name:JOHNSON-HOLLOWAY, LISA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:JOHNSON-HOLLOWAY
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:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-0253
Mailing Address - Country:US
Mailing Address - Phone:860-243-3315
Mailing Address - Fax:860-242-7811
Practice Address - Street 1:701 COTTAGE GROVE RD STE F120
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3095
Practice Address - Country:US
Practice Address - Phone:860-243-3315
Practice Address - Fax:860-242-7811
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2017-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT73261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical