Provider Demographics
NPI:1467674168
Name:JOHNSON, DEIRDRE DEANNE (BSW)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:DEANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1233
Mailing Address - Country:US
Mailing Address - Phone:860-241-0317
Mailing Address - Fax:860-241-0327
Practice Address - Street 1:103 WOODLAND ST
Practice Address - Street 2:51 CAPEN ST HARTFORD CT 06120
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1233
Practice Address - Country:US
Practice Address - Phone:860-241-0317
Practice Address - Fax:860-241-0327
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker