Provider Demographics
NPI:1477715951
Name:JOHNSON, DAVA NAOMI (MS NCC LPC)
Entity Type:Individual
Prefix:MS
First Name:DAVA
Middle Name:NAOMI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS NCC LPC
Other - Prefix:
Other - First Name:DAVA
Other - Middle Name:NAOMI
Other - Last Name:LOWENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 GERMANTOWN ROAD
Mailing Address - Street 2:BEHAVIORAL MEDICINE AND COUNSELING CENTER
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-748-1200
Mailing Address - Fax:203-790-0010
Practice Address - Street 1:20 GERMANTOWN ROAD
Practice Address - Street 2:BEHAVIORAL MEDICINE AND COUNSELING CENTER
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-748-1200
Practice Address - Fax:203-790-0010
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
240001483CT01OtherANTHEM BLUE CROSS BLUE SHIELD ANTHEM BEHAVIORAL HEALTH NE
7967874OtherAETNA