Provider Demographics
NPI:1568052207
Name:JOHNSON, JANEE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JANEE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 S 52ND ST APT 401
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3254
Mailing Address - Country:US
Mailing Address - Phone:215-435-5205
Mailing Address - Fax:
Practice Address - Street 1:705 WYNNEWOOD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3820
Practice Address - Country:US
Practice Address - Phone:215-435-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137664104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty