Provider Demographics
NPI:1427573435
Name:JOHNSEN, ZACHARY (LCSW)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:JOHNSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 SARNO RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3077
Mailing Address - Country:US
Mailing Address - Phone:321-254-3410
Mailing Address - Fax:
Practice Address - Street 1:2098 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3077
Practice Address - Country:US
Practice Address - Phone:321-254-3410
Practice Address - Fax:321-254-9138
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL136481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical