Provider Demographics
NPI:1376765768
Name:JOHNSON, PAMELA DIANNE (LSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DIANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MADISON AVE E
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:NJ
Mailing Address - Zip Code:08049-1409
Mailing Address - Country:US
Mailing Address - Phone:856-541-1700
Mailing Address - Fax:856-309-9716
Practice Address - Street 1:212 MADISON AVE E
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:NJ
Practice Address - Zip Code:08049-1409
Practice Address - Country:US
Practice Address - Phone:856-541-1700
Practice Address - Fax:856-309-9716
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005730E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW005730EOtherLICENSED SOCIAL WORKER