Provider Demographics
NPI:1386656478
Name:JOHNSON, DENISE M WILLIAMS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M WILLIAMS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CENTRAL AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3332
Mailing Address - Country:US
Mailing Address - Phone:973-675-9200
Mailing Address - Fax:973-678-8432
Practice Address - Street 1:185 CENTRAL AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3332
Practice Address - Country:US
Practice Address - Phone:973-675-9200
Practice Address - Fax:973-678-8432
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100288800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJW727145Medicare ID - Type UnspecifiedPROVIDER NUMBER