Provider Demographics
NPI:1568481810
Name:JOHNSON, DEBORAH LEE (RN, CASAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 AMPERSAND DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6500
Mailing Address - Country:US
Mailing Address - Phone:518-562-2780
Mailing Address - Fax:518-562-2783
Practice Address - Street 1:16 AMPERSAND DR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6500
Practice Address - Country:US
Practice Address - Phone:518-562-2780
Practice Address - Fax:518-562-2783
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4200101YA0400X
NY354000-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)