Provider Demographics
NPI:1285856914
Name:CLIMENKO, JOHANNA (LCSW, ADTR, LCAT)
Entity Type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:
Last Name:CLIMENKO
Suffix:
Gender:F
Credentials:LCSW, ADTR, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 8TH AVE
Mailing Address - Street 2:APARTMENT 16H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4828
Mailing Address - Country:US
Mailing Address - Phone:212-989-4949
Mailing Address - Fax:212-924-6567
Practice Address - Street 1:120 RIVERSIDE DR
Practice Address - Street 2:SUITE 2W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3709
Practice Address - Country:US
Practice Address - Phone:212-874-3475
Practice Address - Fax:212-924-6567
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0558411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical