Provider Demographics
NPI:1326482845
Name:JOHNSON, MARIA G (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:JOHNSON
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 1:671 BAUER CT
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4312
Mailing Address - Country:US
Mailing Address - Phone:516-451-1258
Mailing Address - Fax:516-285-1616
Practice Address - Street 1:430 W MERRICK RD
Practice Address - Street 2:SUITE 25
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5201
Practice Address - Country:US
Practice Address - Phone:516-451-1258
Practice Address - Fax:516-285-1616
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0804801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080480OtherLICENSED CLINICAL SOCIAL WORKER
NY8118596OtherREGISTERED LICENSED CLINICAL SOCIAL WORKER