Provider Demographics
NPI:1568183762
Name:JOHNSTON, TIMOTHY (LSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 DANBY RD STE 202F
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5714
Mailing Address - Country:US
Mailing Address - Phone:072-603-1006
Mailing Address - Fax:607-241-9972
Practice Address - Street 1:950 DANBY RD STE 202F
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5714
Practice Address - Country:US
Practice Address - Phone:607-260-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1189291041C0700X
PASW139720104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker