Provider Demographics
NPI:1255303418
Name:JOHNSON, JENNIFER L (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-2143
Mailing Address - Country:US
Mailing Address - Phone:908-561-8032
Mailing Address - Fax:
Practice Address - Street 1:2284 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-4697
Practice Address - Country:US
Practice Address - Phone:908-561-8032
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052617001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0886350886OtherNASW NUMBER
NJ44SC05261700OtherLCSW LICENSE NUMBER
NJ44SC05261700OtherLCSW LICENSE NUMBER