Provider Demographics
NPI:1467225375
Name:JOHNSON, SAMANTHA EVE (LMFT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:EVE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALLENS CREEK RD STE 280
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3314
Mailing Address - Country:US
Mailing Address - Phone:650-477-0426
Mailing Address - Fax:
Practice Address - Street 1:160 ALLENS CREEK RD STE 280
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3314
Practice Address - Country:US
Practice Address - Phone:650-477-0426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002180106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist