Provider Demographics
NPI:1417483637
Name:JOHNSON, REENA JAYANT (LCSW, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:REENA
Middle Name:JAYANT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RT 9
Mailing Address - Street 2:OCEAN MENTAL HEALTH SERVICES
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721
Mailing Address - Country:US
Mailing Address - Phone:732-349-1977
Mailing Address - Fax:732-349-6702
Practice Address - Street 1:160 ROUTE 9
Practice Address - Street 2:BAYVILLE
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1229
Practice Address - Country:US
Practice Address - Phone:732-349-1977
Practice Address - Fax:732-349-6702
Is Sole Proprietor?:No
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00258600101YA0400X
NJ44SC057168001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ210722291Medicaid