Provider Demographics
NPI:1447394028
Name:JOHNSON-BUDA, JOANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:JOHNSON-BUDA
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 1:3638 MIDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1713
Mailing Address - Country:US
Mailing Address - Phone:215-825-7686
Mailing Address - Fax:
Practice Address - Street 1:1218 CHESTNUT ST
Practice Address - Street 2:SUITE 607
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4825
Practice Address - Country:US
Practice Address - Phone:215-625-9655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical