Provider Demographics
NPI:1235876061
Name:JOHNSON, KATHERINE BAILEY (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BAILEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OLD ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-3417
Mailing Address - Country:US
Mailing Address - Phone:914-490-1817
Mailing Address - Fax:
Practice Address - Street 1:3 OLD ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-3417
Practice Address - Country:US
Practice Address - Phone:914-490-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health