Provider Demographics
NPI:1306867148
Name:JOHNSON, CAROL A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:KOVACS
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 HAMBURG TPKE
Mailing Address - Street 2:STE 303
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-790-9222
Mailing Address - Fax:973-790-0671
Practice Address - Street 1:401 HAMBURG TPKE
Practice Address - Street 2:STE 303
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-790-9222
Practice Address - Fax:973-790-0671
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ445C001754001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ039874Medicare ID - Type UnspecifiedGROUP NUMBER
NJ645944VNDMedicare ID - Type Unspecified
NJ645944N90Medicare ID - Type Unspecified
NJ103241Medicare ID - Type UnspecifiedGROUP NUMBER